Care Theory Compare and Contrast Paper
Jean Watson’s Theory of human caring is based on transpersonal relationships and developing a caring environment that offers the development potential while allowing the person to choose the best course of action. Through interactions with others we learn how to recognize ourselves in others. Watson believes that through these interactions humanity is preserved. John Paley’s article A Slave Morality: Nietzchean themes in nursing ethics criticizes Watson’s theory that caring is central to nursing. The purpose of this paper is to compare and contrast John Paley’s article to Jean Watson’s Commentary on Shattle M (2004) Nurse-patient interaction: A review of the literature. A discussion of Watson’s background and care theory; John Paley’s background, and a brief discussion Friedich Nietzschen’s major philosophical beliefs.
Jean Watson’s background Jean Watson was born in West Virginia in 1940. She graduated from the University of Colorado where she earned her BSN, MS, and in 1973 her PhD. Dr. Watson is widely published and has received many awards and honors. She is a distinguished professor of nursing and endowed chair in Caring Health Science. She is also a fellow at the American Academy of nursing. Watson’s research specialized in loss and human caring. She developed the Theory of Transpersonal Caring, which is also referred to as The Caring Model in the late 1970’s. Her theory evolved over many years, but the principles have remained the same: to combine human caring with the knowledge of science.
Jean Watson’s Care Theory
Watson’s theory had four major concepts. She believed human beings are to be valued, respected, understood, nurtured, and cared for. Watson added three elements to the WHO definition of “health”: a patient will experience a high level of functioning, absence of illness, and can perform activities of daily living at an acceptable level. She stated that a caring attitude transmits culturally with use of its environment. Last, Watson believed that nursing focuses on preventative health, caring for the sick, and restoration of health. She believed that in the practice of caring in nursing, holistic care is fundamental (Current Nursing, 2011)
John Paley’s background
John Paley is a Senior lecture at the University of Stirling, School of Nursing, Midwifery, and Health in Stirling, Scotland. He teaches research methods, philosophy and ethics, clinical cognition, organization and management. He is one of the most influential theorists in modern nursing (University of Stirling, n.d.). Paley’s research includes nursing's appropriation of phenomenology, The philosophy of qualitative research, professional ethics, nursing applications of the philosophy of mind, clinical cognition, and dynamic systems in health care (University of Stirling, n.d.). His 2002 article ‘Caring as a slave morality: Nietzschean themes in nursing ethics’, criticizes Jean Watson notion of caring as central idea in nursing practice.
Friedich Nietzsche Friedrich Nietzsche’s (1844- 1900) ideas on truth, religion, morality, history, nihilism, power, and meaning of existence have had an enormous influence on modern Western philosophy (Internet Encyclopedia of Philosophy, 2009). His works remain highly controversial and there is widespread disagreement about their interpretation and significance. Some of the major concepts of his ideas in a very simplified way include Nihilism and the revaluation of values. Nihilism argues that life does not have a purpose or intrinsic value. Nietzche criticizes Christianity and the establishment of moral systems based on a dichotomy of good and evil. He suggests a reevaluation of the Judeo-Christian values and the idea of God is dead means that the idea of God can no longer provide values (Internet Encyclopedia of Philosophy, 2009).
According to Nietzsche’s Genealogy, the common people or the slaves, are powerless, weak and miserable, and have developed feelings or resentment (ressentiment) for the ruling class or the noble, who are strong and happy. The slaves’ leaders (the priests) initiate the revolt creating new values and attacking the ruling class as evil. The slave class as the nobles, aspires to strength and power, but has no prospect on achieving either. The will to power, the desire to obtain power, is the most important concept to better explain the human behavior. Eternal recurrence or eternal return means that the universe has been recurring and will continue to recur in a cyclical way (Internet Encyclopedia of Philosophy, 2009).
Contrast between Watson’s Care Theory with John Paley’s article Paley’s hypothesis is that doctors are the masters and nurses the slaves. Traditionally the medical profession has been overwhelmingly dominant with nursing having a position of “submissiveness”, “subordination” and “obedience”. Extrapolating Nietzsche’s ideas, nursing’s inferiority fosters ressentiment. In the same way their priests (nursing theorists) develop new slave values or a new nursing moral authority. Essentially all values of the medical model become non-moral, the opposite of these values become the paradigm of the “caring paradigm”: the absence of science, the absence of focus and “caring” or the absence of clinical detachment. As with Nietzsche’s slaves these feeling of revenge are fuelled by the wish to obtain power; however the political balance remains unchanged (Paley, 2002).
Paley believes that the nursing “revolt” that took place mainly in the second half of the 70’s with rapid increase in doctoral programs in the United States was the wrong response to medical domination. The ideology of caring is in essence a slave morality, an attack on the medical scientific model motivated by resentment, designed to establish nursing’s superiority. Taking the phenomenological approach had actually weakened nursing, inhibited nursing development toward scientific investigation and prevented nursing from becoming a “noble” discipline (Paley, 2002). Paley views recovery and rehabilitation to be the core of nursing in contrast to Watson, who views caring to be the core of nursing. Paley believes caring to be optional in nursing.
Many people feel there is a non-caring atmosphere in health care today. The rapidly changing health care system and need for health care reform in the United States has created a non-caring trend in healthcare institutions. According to Watson (2009), “what is needed is a deeper, philosophical, value-based approach relevant to sustaining the integrity and dignity of the profession of nursing, which has the largest number of practitioners in the healthcare system and in society” (p. 467). Caring relationships is the most valuable resource health care providers have. The public is more aware of and knowledgeable about leading a life of spiritual wellbeing and wholeness. The advances in technology have led to a healthcare system that is cold and seemingly uncaring. The creative solution to reform is based on human relationships, communication, and trust that promote self-insight, self-control, and self-knowledge by the public (Watson, 2004).
Compare Watson’s Care John Paley’s article Jean Watson’s theory of Human Caring was published in 1988 in Nursing: Human Science & Human Caring. She believes the science of caring is complementary to the science of curing. The science of caring should not always be neutral and objective. Watson based her theory on her own beliefs and values. One of her basic premises was “people need each other in a caring, loving way. Loving and caring are two universal givens" (Watson, 1999, p. 49).
Paley (2002) states “Scientific method becomes ‘positivist’, the biological stratum is ‘reductionist’ and the clinical dispassion is rejected as ‘mechanistic’, the symptoms of a lack of concern for the ‘person’ behind the patient” (p. 29). Paley goes on to say these qualities lack respect for the unique individual medicine is treating. These qualities can be called upon when needed, but also can be suspended to foster a more caring practitioner-patient relationship. Nursing as a science pulls from several disciplines. “If nursing is to become a proper ‘science’ then its specific contribution is clear; it is the science of recovery and rehabilitation” (Paley, 2002, p. 32). Nursing will become a noble profession when nurses learn to do proper science (Paley, 2002).
Conclusion
Paley and Watson have differing views of what nursing is. The conventional medical-clinical, technology-driven, cure orientation to health and illness has led nursing to shift toward a spiritualizing of health. Watson puts caring and transpersonal relationship at the center of what nursing is. The science of nursing is complimentary to the science of curing. Paley agrees that nursing cannot limit itself solely to the disease process. To heal there needs to be a healing environment, but he believes caring to be optional in the nurse-patient relationship. Competence and knowledge are more valuable qualities in a nurse. He argues that the only knowledge that is important is that which can be measured or observed. Watson supports the need to development other ways of knowing. For the preservation of humanity the science of caring should not always be neutral and objective.
References
Current Nursing. (2011). Jean Watson's philosophy of nursing. Retrieved from http://currentnursing.com/nursing_theory/Watson.html Internet Encyclopedia of Philosophy. (2009). Friedrich Nietzsche. Retrieved from http://www.iep.utm.edu/nietzsch/
Paley,J. (2002). Caring as a slave morality: Nietzschean themes in nursing ethics. Journal of Advanced Nursing, Oct; 40(1): 25-35.
University of Stirling. (n.d.). School of Nursing, Midwifery and Health. Retrieved from http://www.nm.stir.ac.uk/people/john-paley.php
Watson, J. (1999). Nursing: Human science and human care, a theory of nursing. Sunbury, MA: NLN Press, Jones and Bartlett.
Watson, J. (2005, April). Commentary on Shattell M (2004) Nurse–patient interaction: A review of the literature. Journal of Clinical Nursing 13, 714–722. Journal of Clinical Nursing, 14(4), 530-532.