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All these activities, experiences, questions, and processes transcend illness, diagnosis, condition, setting, and so on; they were, and remain, enduring and timeless across time and space and changes in systems, society, civilization, and science.
The original work has expanded and evolved through a gen- eration of publications, other books, videos, and CDs, along with clin- ical-educational and administrative initiatives for transforming profes- sional nursing. A series of other books on caring theory followed and have been translated into at least nine languages.
A Theory of Nursing New York: National League for Nursing. Edinburgh, Scotland: Churchill-Livingstone. Philadelphia: F. See also Web site Watson a for complete citations of books and publications. These factors were identified as the essential aspects of caring in nursing, without which nurses may not have been practic- ing professional nursing but instead were functioning as technicians or skilled workers within the dominant framework of medical techno- cure science.
This work has stood as a timeless classic of sorts on its own. It has not been revised since its original publication; only reprints have kept it alive, thanks to the University Press of Colorado.
This edition is an expanded and updated supplement of the original text, with completely new sections replacing previous sections while other sections that remain relevant are included with only minor revisions. I have been advised to retain the original text in this revision so essential parts of it remain alive, since the original version may eventually go out of print. Thus, this work retains core essentials of the original text while updating that text with new content, bringing the original book full circle with my own evolution and changes in the work across an almost thirty-year span.
To provide the context for this evolution before I address revi- sions of the original text , I provide a brief overview of the focus and content of the other books that serve as a background for my evolv- ing work, all of which emerged from the original text of Nursing: The Philosophy and Science of Caring.
It expands on the philosophical, transpersonal aspects of a caring moment as the core framework. This second theory text seeks to make more explicit the reality that if nursing is to survive in this millennium, it has to sustain and make explicit its covenant with the public.
This covenant includes taking mature professional responsibility for giving voice to, standing up for, and acting on its knowledge, values, ethics, and skilled practices of caring, healing, and health.
Watson Thus, a human science and human caring orientation differs from con- ventional science and invites qualitatively different aspects to be hon- ored as legitimate and necessary when working with human experi- ences and human caring-healing, health, and life phenomena.
What we all learn from it is self-knowledge. The self we learn about or dis- cover is every self: it is universal. This human-to-human connection expands our compassion and caring and keeps alive our common humanity. All of this process deepens and sustains our shared humanity and helps to avoid reducing another human being to the moral status of object Watson This second work concludes with a sample of human science meth- odology as a form of caring inquiry.
Transcendental phenomenology is discussed as one exemplar of a human science—Caring Science experi- ence of loss and grief experienced and researched among an Aboriginal tribe in Western Australia. Thus, the transcendent views were consistent with transpersonal dimensions and provided space for paradox, ambiguity, sensuous reso- nance, and creative expressions, going beyond the surface phenom- enology Watson — Finally, this second book launched my ideas and set the foun- dation for the next evolution of my work on Caring Science that followed.
The third book, Postmodern Nursing and Beyond , brought focus to the professional paradigm that is grounded in the ontology of relations and an ethical-ontological foundation before jumping to the epistemology of science and technology. In this book the spiritual and evolved energetic aspects of caring consciousness, intentionality, and human presence and the personal evolution of the practitioner became more devel- oped.
This evolution was placed within the emerging postmodern cos- mology of healing, wholeness, and oneness that is an honoring of the unity of all. This postmodern perspective, as developed in the third book, attempts to project nursing and health care into the mid-twenty- first century, when there will be radically different requirements for all health practitioners and entirely different roles and expectations between and among the public and health care systems Watson xiii.
Prominent in this text is an emphasis on the feminine yin energy needed for caring and healing, which nursing, other practitioners, and society alike are rediscovering because the dominant system is imbal- anced with the archetypal energy of yang, which is not the source for healing. Nursing itself serves as an archetype for healing and rep- resents a metaphor for the deep yin healing energy that is emerging within an entirely different paradigm. What is proposed is a funda- mental ontological shift in consciousness, acknowledging a symbiotic relationship between humankind-technology-nature and the larger, expanding universe.
This evolutionary turn evokes a return to the sacred core of humankind, inviting mystery and wonder back into our lives, work, and world. Such views reintroduce a sense of reverence for and openness to infinite possibilities. My most recent theoretical book, Caring Science as Sacred Science which received an American Journal of Nursing [AJN] Book of the Year award in in the category of research , expands further upon the earlier works on caring.
This work places Caring Science within an ethical—moral—philosophically evolved, scientific context, guided by the works of Emmanual Levinas , French and Knud Logstrup , Danish. This latest work on Caring Science seeks a science model that reintegrates metaphysics within the material physical domain and reinvites Ethics-of-Belonging to the infinite field of Universal Cosmic Love Levinas as before and underneath Being-by-Itself alone— no longer separate from the broader universal field of infinity to which we all belong and to which we return from the earth plane.
Indeed, it has been acknowledged in peren- nial philosophies and Wisdom Traditions across time, cultures, and a diversity of belief systems that the greatest source of healing is love. Thus, my book on Caring Science brings a decidedly sacred dimen- sion to the work of caring, making more explicit that we dwell in mys- tery and the infinity of Cosmic Love as the source and depth of all of life.
We come from the spirit world and return to the spirit source when vulnerable, stressed, fearful, ill, and so forth. In this framework it is acknowledged that we are working with the inner life forces, life energy, and the soul, if you will, of self and other and that we need to connect with the universal infinite field.
He [sic] experiences [self], thoughts and feelings, as something separated from the rest, a kind of optical illusion. Our task must be to free ourselves from this prison [of illusion] by widening our circle of compassion [love and caring] to embrace all living creatures and the whole of nature in all its beauty.
Nobody is able to achieve this completely, but the striving for such achievement is in itself part of the libera- tion. Albert Einstein quoted on title page of Williamson When we are conscious of an expanded cosmology and an expanded, deeper moral-ethical foundation, we gain new insights and awakenings; we open to the sense of humanity-in-relation-to-the- larger-universe, inspiring a sense of wonder, wisdom, awe, and humil- ity.
We are invited to accept our need for wisdom, beyond information and knowledge alone, and to surrender to both that which is greater than our separate ego-self and the outer world we think we have con- trol over and seek to manipulate. In the present work I reassert the emerging, evolving wonder at and appreciation for viewing the human-universe as One. The holo- graphic view of caring mirrors the holographic universe: that is, the whole is in each part, and each part affects the whole.
So, in developing concepts and practices, theories and philoso- phies of caring-healing that intersect with Love, we invoke Caring as part of our consciousness and intention to affect the whole with prac- tical engagement from our own unique gifts and talents.
In doing so, our part of personal and professional work is contributing to and mak- ing a difference in the moment but is also affecting the holographic universal field that surrounds us and to which we all belong. If one person is healed, it is helping to heal all. If others are healed, it helps us heal. The mutu- ality of Caring affects the universal field to which we all belong, and we energetically affect it with our consciousness and our concrete acts.
I now, thirty years later, after offering an overview and update of the previous texts of my evolved work in Caring Science and the Theory of Human Caring, turn back to the original text and offer revi- sions and current perspectives for the new edition. Ironically, and per- haps not surprisingly, the original text held the blueprint for the evolu- tion of these ideas that have both sustained and expanded over these years. I now ponder suggesting that today, almost thirty years later, it perhaps could equally be framed as Caring: The Philosophy and Science of Nursing.
Discussions and ambiguity remain as to the nature of Caring Science and its relation to nursing sci- ence.
Rhetorical questions arise, such as, are there distinct differences between the two? Do they overlap? Do they intersect? Are they one and the same? These questions perhaps remain, but the present work offers a distinct position. By transposing the order of Nursing and Caring, it invites a new discourse and context. It reintroduces spirit and sacred dimensions back into our work and life and world.
It allows for a reunion between metaphysics and the material-physical world of modern science. In positing Caring Science as the disciplinary context and matrix that guides professional development and maturity, I acknowledge that there is a difference between the discipline of nursing and the pro- fession of nursing. It is widely known that the discipline of any field should inform the profession. The profession, without clarity of its disciplinary con- text, loses its way in the midst of the outer-worldly changes and forces for conformity to the status quo of the moment.
If nursing across time had been born and matured within the consciousness and clarity of a Caring Science orientation, perhaps it would be in a very different evolved place today: a place beyond the struggles with conventional biomedical-technical science that linger still, beyond the crisis in care that haunts hospitals and systems today, beyond the critical shortage of nurses and nursing that society is expe- riencing at this turn in history, and beyond the noncaring communities in our life and world.
Our world is increasingly struggling with wars, violence, and inhumane acts—be they human-to human, human-to- environment, or human-to-nature. In spite of an evolved cosmology for all disciplines today, includ- ing physics and basic sciences and other scientific fields, we still often find ourselves locked in outdated thinking within a separatist-material- physical world ontology and an outer-worldview as our starting point. Caring Science makes more explicit that unity and connectedness exist among all things in the great circle of life: change, illness, suffering, death, and rebirth.
A Caring Science orientation moves humanity closer to a moral com- munity, closer to peaceful relationships with self—other communities— nations, states, other worlds, and time. Its social, moral, and scientific contributions lie in its professional commitment to the values, ethics, and ideals of Caring Science in theory, prac- tice, and research. Every society has had some people who have cared for others.
A caring atti- tude is not transmitted from generation to generation by genes. It is transmitted by the culture of a society. The culture of nurs- ing, in this instance the discipline and profession of nursing, has a vital social-scientific role in advancing, sustaining, and preserv- ing human caring as a way of fulfilling its mission to society and broader humanity.
Caring is considered as one central feature within the meta- paradigm of nursing knowledge and practice. It is located within a worldview that is non-dualistic, relational, and unified, wherein there is a connectedness to All: the universal field of Infinity: Cosmic love. Caring Science within this worldview intersects with the arts and humanities and related fields of study and practice. Caring: Science-Arts-Humanities To understand nursing as a discipline and a distinct field of study is to honor it within a context of art, the humanities, and expanding views of science.
As a distinct discipline, it is necessary to acknowledge that nursing and Caring reside within a humanitarian as well as a scientific matrix; thus, there is an intersection among the arts, humanities, phi- losophy, science, and technology. The discipline encompasses a broad worldview that honors evolving humanity and an evolving universe that is full of wonder and unknowns as well as known set expectations about our world. Just as the profession may detour at times from its disciplinary heritage, so too we often forget that an equal need exists for humanis- tic-aesthetic views of a similar phenomenon.
Humanities and the arts seek to answer different questions than science does. It continues to be important to understand the essential characteristics they all bring and the ways in which they are similar and different and in which they also converge. For example, conventional science is concerned with order, pre- diction, control, methods, generalizations, detachment, objectivity, and so forth.
Science in this context cannot answer certain questions about humanity, about caring and what it means to be human.
Science generally is not concerned with specific individual responses but more with prediction and generalizations about anonymous others.
It cannot be expected or called upon to keep alive a sense of common humanity Watson It does not offer insights into depth of human experiences such as pain, joy, suffering, fear, forgiveness, love, and so on. Such in-depth exploration of human- ity is expressed and pondered through study of philosophy, drama, the arts, film, literature, humanistic studies in the liberal arts, humani- ties proper, and so on. This perspective is learned through self-knowl- edge, self-discovery, and shared human experiences, combined with the study of human emotions and relations that mirror our shared humanity.
In spite of inherent differences between science and the humani- ties, both fields and, in fact, all fields of study are changing, expand- ing, growing into new dynamic intersections between and among each other. There is a convergence between and among art, science, and spirituality; this convergence is becoming more prevalent among emerging models of mind-body-spirit medicine, so-called comple- mentary-alternative-integrative medicine, and new understandings of the physics of science, energy medicine, spirituality and healing, and so forth.
As Housden put it, art helps our eyes see more than they usually do: about life in general but also about ourselves. The same can be said for the humanities, drama, and also science, opening up a new horizon of meaning and possibilities. In considering Caring Science, art, the humanities, and the beauty of science and life itself all come into play. No reason can be asked or given why the soul seeks beauty. It is this engagement in art and a sense of beauty that gives rise to wonder, to questioning, and to pondering our Being.
The art and science of caring-healing is emerging in mainstream medicine and nursing, as the public has a hunger for the intersection among art, science, beauty, and spiritual dimensions of the healing arts and health and also has a greater sense of self-knowledge, self- control, and well-being.
In any event, in nursing and caring-healing work, we draw upon healing arts in a more expanded way that integrates science, art, beauty, and spirituality. Diverse categories of healing arts are emerging. Lafo, Capasso, and Roberts Caring Science seeks to combine science with the humanities and arts. Caring Science is not neutral with respect to human values, goals, subjective individual perceptions, and meanings.
It is not detached from human emotions and their diverse expressions, be they cultur- ally bound or individually revealed. The discipline of nursing—guided by a Caring Science orienta- tion—seeks to study, research, explore, identify, describe, express, and question the relation and intersection between and among the ethi- cal, ontological, epistemological, methodological, pedagogical, and praxis aspects of nursing, including health policies and administra- tive practices.
Thus, a Caring Science orientation seeks congruence between and among clinical nursing science, humanities, the arts, and the human subject matter and phenomena of caring knowledge and practices. This form of Being is a form of human literacy, human artistry.
Such literacy includes an evolved and continually evolving emo- tional heart intelligence, consciousness, and intentionality and level of sensitivity and efficacy, followed by a continuing lifelong process and journey of self-growth and self-awareness. Perhaps this requirement was and has always been present in the tradition of heal- ing professions, but somewhere along the way professional education and practices took a detour from the very foundation of our shared humanity.
A return to a focus on Ontological Competencies, within the evolved notion of Caring Literacy, seems essential to balance and carry out the pervasive technological competencies, helping to make these skills and forms of Being part of the requirements for nursing education and practice. For more exploration of these ideas within the context of Nightingale, see Watson chapter In addition, an emerging project from the International Caritas Consortium ICC is focused on Caring Literacy and Caritas Literacy, seeking more and more specificity in the knowledge, skills, and ways of being to manifest such literacy.
A working document is found in the Addenda as well as on the Web site www. It is found in Addendum III. This latest ICC document on Caritas Literacy is based on meetings, dialogue, and previous work among the subgroup members: J. I invite readers to identify the ontological-literacy processes they bring to their caring-healing practice and to continue to contribute to more specificity so these practices can be taught, documented, researched, and practiced. Thus, the nurse is invited to engage in significant insight into the Nurse-Self as an energetic-vibrational field of consciousness and inten- tionality Quinn , affecting the entire environment for better or for worse.
As the nurse cultivates these ontological literate abilities and sensitivities of caring, there is an invitation to open to inner healing processes that expand to infinite new possibilities. Ontological—Caring Literacy directions serve only as examples of the intersection between technological competencies and emotional- intellectual literacy of human caring skills of Being-Caring.
Such explo- ration into the literacy of caring incorporates the ethical, philosophi- cal, and theoretical foundations of professional caring-healing. This view of Caring Literacy serves as core knowledge that leads directly back to the original Carative Factors and the evolution toward Caritas Consciousness and Caritas Processes. These evolved concepts are pre- sented in Chapter 2. This revised, updated edition builds upon the primary source mate- rial from the text and its evolution from what is known as the ten Carative Factors CFs toward ten Caritas Processes CPs.
Likewise, this revision incorporates ideas from my previous published works, sum- marized and developed as background in Section I. Table 2. The original ten Carative Factors, juxtaposed against the emerging Caritas Processes, are summarized in Table 2. Formation of a humanistic-altruistic system of values 2. Instillation of faith-hope 3. Cultivation of sensitivity to oneself and others 4. Development of a helping-trusting relationship 5.
Promotion and acceptance of the expression of positive and negative feelings 6. Systematic use of the scientific problem-solving method for decision making refined in as use of creative problem-solving caring process 7. Promotion of interpersonal teaching-learning 8. Provision for a supportive, protective, and or corrective mental, physical, sociocul- tural, and spiritual environment 9. Assistance with gratification of human needs Watson Nursing: The Philosophy and Science of Caring.
Boston: Little, Brown, 9— The ten original Carative Factors remain the timeless structural core of the theory while allowing for their evolving emergence into more fluid aspects of the model captured by the ten Caritas Processes. In introducing the original concept of Carative Factors as the core for a nursing philosophy and science, I was offering a theoreti- cal counterpoint to the notion of Curative, so dominant in medical science.
Thus, the Carative Factors provided a framework to hold the discipline and profession of nursing; they were informed by a deeper vision and ethical commitment to the human dimensions of caring in nursing—the art and human science context. I was seeking to address those aspects of professional nursing that transcended medical diagno- sis, disease, setting, limited and changing knowledge, and the techno- logical emphasis on very specialized phenomena. I was asking, What remains as core? Humanistic-altruistic values 1.
Practicing loving-kindness and equanimity for self and other 2. Cultivating sensitivity to oneself 3. Developing a helping-trusting, 4. Developing and sustaining a helping-trusting, human caring relationship authentic caring relationship 5.
Promoting and accepting 5. Being present to, and supportive of, the expres- expression of positive and sion of positive and negative feelings as a con- negative feelings nection with deeper spirit of self and the one- being-cared-for 6. Systematic use of scientific 6. Promoting transpersonal 7. Providing for a supportive, 8. Reverentially and respectfully assisting with basic needs; holding an intentional, caring con- sciousness of touching and working with the embodied spirit of another, honoring unity of Being; allowing for spirit-filled connection Allowing for existential- Sources: J.
Boston: Little, Brown; www. I identified these ten factors as the core activities and orientations a professional nurse uses in the delivery of care. They are the common and necessary professional practices that sustain and reveal nursing as a distinct caring profession, not as comprising a group of technicians. Nurses apply the CFs constantly but are not aware of them, nor have they necessarily named them. Thus, nurses generally are not conscious of their own phenomena; they do not have the language to identify, chart, and communicate systematically and so on.
This is a result of both a lack of awareness and terminology of caring and of recognized knowledge of those everyday practices that define their work.
Without an awareness, additional education, and advancement of professional caring in nursing, these factors are likely to occur in an ad hoc, rather than a systematic, fashion. If nurses are committed to a model of professional caring-healing, going beyond conventional medicalized-clinical routines and indus- trial product-line views of nursing and humanity , yet do not have a theoretical guide to honor, frame, discuss, develop, and advance their profession, a demoralized experience and despair set in over time Swanson If this continues, there is little hope for the survival of professional nursing and its caring-healing practices.
Without honoring and attend- ing to Caring Science knowledge and practices, nursing will not be fulfilling its scientific, ethical, professional covenant with its public or even with itself. Moving from Carative to Caritas From an academic standpoint related to knowledge development and theory evolution, one can consider that I used the technical pro- cess of concept derivation Walker and Avant and extension in transposing and redefining Carative Factors to Caritas Processes.
That is, in working within the original field of Nursing and Carative think- ing, I sought to redefine Carative from the parent field, Nursing, to the new field of Caring Science with its explicit ethic, worldview, and so on.
The broader field of Caring Science and its expanded cos- mology of unity, belonging, and infinity of the universal field of Love allowed for a more meaningful redefinition for the phenomenon of Caritas Nursing to result.
As the transposition from Carative Nursing to Caritas Caring Science occurred, a new vocabulary for an ontological phenomenon was revealed, allowing for new ways of thinking about caring and inviting a new image, even a metaphor, of caring-healing practices to develop.
While each of the original Carative Factors has been transposed and extended into the new language of Caritas, several core principles are the most essential with respect to a change in consciousness.
These five cultivated areas of Caritas are those that help distinguish the core differences between the notions of Carative and Caritas. In moving from the concept of Carative to Caritas, I am overtly evoking Love and Caring to merge into an expanded paradigm for the future.
Such a perspective ironically places nursing in its most mature paradigm while reconnecting with the heritage and foundation of Nightingale. With Caritas incorporated more explicitly, it locates the theory within an ethical and ontological context as the starting point for considering not only its science but also its societal mission for humanity. This direction makes a more formal connection between caring and healing and the evolved human consciousness.
The back- ground for this work is available in Watson a. Emergence of Caritas Nursing and the Caritas Nurse My evolution toward Caritas Processes is intended to offer a more fluid language for understanding a deeper, more comprehensive level of the work, as well as guidance toward how to enter into, interpret, sustain, and inquire about the intention and consciousness behind the original Carative Factors.
Moreover, Caritas captures a deeper phenomenon, a new image that intersects professional-personal practices while open- ing up a new field of inquiry for nursing and Caring Science. However, as one steps into this new work, it is important to con- sider both the original CFs and the evolved CPs holographically, in that the whole is in any and every part.
What is emerging throughout this shift to Caritas Processes is an acknowledgment of a deeper form of nursing: Caritas Nursing and the Caritas Nurse. This caring consciousness orientation informs the professional actions and relationships of a Caritas Nurse, even while she or he is engaged in the required routine or dramatic, practical-technical world of clinical practices. How is such a value system to be cultivated and sustained for professional caring practices? These are only some examples of how to enter into and sustain this professional ethic of altruism and loving-kindness.
This work is related not only to caring but also to the health and healing of practitioner as well as patient. It is Love in the fullest universal, cosmic sense. What is the greatest source of Healing? It, too, is Love.
Thus, one can better appreciate the gifts of giving and receiving, being there for another person to offer presence, loving consciousness, and informed moral caring actions in the midst of suffering, despair, love, hate, illness, sorrow, questions, trauma, unknowns, fears, hopes, and so on. This level of consciousness with which to enter and sus- tain professional caring in nursing, while honoring our deep human- ity, is founded on a very different model than conventional nursing and medicine.
This mode of Caritas thinking invites a total transformation of self and systems. In this model of Caring Science, the changes occur not from the outer focus on systems but from that deep inner place within the creativity of the human spirit. At the same time, the shift allows for nurses and nursing to evolve toward accessing a more fluid, expressive language for com- prehending and articulating the deeper meaning behind the original factors.
Teilhard de Chardin Caritas comes from the Latin word meaning to cherish, to appre- ciate, to give special, if not loving, attention to. It represents char- ity and compassion, generosity of spirit. It connotes something very fine, indeed, something precious that needs to be cultivated and sustained. Bringing Love and Caring together this way invites a form of deep transpersonal caring. While health may be considered to represent expanding con- sciousness, Love is the highest level of consciousness and the great- est source of all healing in the world.
This connection with Love as a source for healing extends from the individual self to nature and the larger universe, which is evolving and unfolding.
This cosmology and worldview of Caring and Love—Caritas—is both grounded and meta- physical; it is immanent and transcendent with the co-evolving human in the universe Watson , a. It is when we include and bring together Caring and Love in our work and our lives that we discover and affirm that nursing, like teach- ing, is more than a job.
It is a life-giving and life-receiving career for a lifetime of growth and learning. It is maturing in an awakening and an awareness that nursing has much more to offer humankind than sim- ply being an extension of an outdated model of medicine and medical- techno-cure science.
Nursing helps sustain human dignity and human- ity itself while contributing to the evolution of human consciousness, helping to move toward a more humane and caring moral community and civilization. As nursing more publicly and professionally asserts these positions from a Caring Science context for its theories, ethics, and practices, we are invited to relocate ourselves and our profession away from a dominant medical science mind-set.
Such thinking calls forth a sense of reverence and sacred- ness with regard to our work, our lives, and all living things. It incorpo- rates art, science, and spirituality as they are being redefined.
Each person is asked, invited, if not enticed, to examine, explore, challenge, and question for self and for the profession the critical intersections between the personal and the professional. This revised work calls each of us into our deepest self to give new meaning to our lives and work, to explore how our unique gifts, talents, and skills can be translated into compassionate human car- ing—healing service for self and others and even the planet Earth. It is hoped that at some level this work will help us all, in the caring-healing professions, to remember who we are and why we have come here to do this work in the world.
Return to Love as the Basis for Caritas Consciousness and Gratitude Toward Self-Others In a world like ours, where death is increasingly drained of mean- ing, individual authenticity lies in what we can find that is worth living for. And the only thing worth living for is love.
Love for one another. Love for ourselves. Love of our work. Love of our destiny, whatever it may be. Love for our difficulties. Love of life. The love that could free us from the mysterious cycles of suffering.
The love that releases us from our self-imprisonment, from our bitterness, our greed, our madness-engendering competitiveness.
The love that can make us breathe again. Love a great and beautiful cause, a wonderful vision. A great love for another, or for the future. The love that reconciles us to ourselves, to our simple joys, and to our undiscovered repletion.
A creative love. A love touched with the sublime. Love and compassion must begin with kindness toward ourselves. One of the greatest blocks to loving kindness is our own sense of unworthiness. Kornfield , , The Carative Factor: Formation of Humanistic-Altruistic Values system continues to lay the foundation as a starting point for Caring Science. Such a system helps us to tolerate difference and view others through their subjective worldview rather than ours alone. These emotions of love, kindness, gentleness, compassion, equa- nimity, and so on are intrinsic to all humans.
These emotions and expe- riences are the essence of what makes us human and what deepens our humanity and our connection with the human spirit.
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