Critical Appraisal of Jean Watson’s Theory of Human Caring

Critical Appraisal of Jean Watson’s Theory of Human Caring

Jean Watson’s theory of human caring emphasizes a holistic perspective and transpersonal psychology of professional care. According to Wei & Watson (2019), this theory focuses on the Ten Caritas Processes, including fostering patients’ spiritual practices, valuing humanity, inspiring hope and faith, nurturing relationships, and embracing love and kindness. Aghaei, Vanaki & Mohammadi (2020) argue that Watson’s theory promotes human dignity, establishes harmony between mind, body, and soul, and care provision based on human values. A humanistic perspective of nursing practice has strengthened the application of Watson’s theory in different care settings. The current scholarly literature explores the contribution of this theory in various clinical settings, including palliative care and psychiatry. Therefore, this paper critically appraises an evidence source that examines the effects of the clinical education program based on Watson’s theory of human caring on the coping and anxiety levels of nursing students.

Critical Appraisal of the Evidence Source

Type of the Study and Design

In the scholarly article “The Effects of clinical education program based on Watson’s Theory of human caring on Coping and anxiety levels of nursing students: A randomized controlled trial,” Ozan et al. (2019) conducted a single-blind, randomized controlled trials to examine the effect of the clinical education program inspired by Watson’s theory on coping and anxiety levels. The researchers hypothesized that implementing the clinical education program based on Watson’s theory of human caring would contribute to low anxiety levels, higher levels of using appropriate coping strategies, and minimal likelihood of applying negative methods of coping with stress. According to Melnyk & Fineout-Overholt (2019), randomized controlled trials (RCTs) are profound quantitative research designs for answering foreground questions, testing the efficacy and effectiveness of interventions, and establishing the causal relationship between an intervention and a particular outcome. This research design is level II evidence in the hierarchy of evidence due to the likelihood of a low risk of bias.

Quality of the Study

The quality of a randomized controlled trial is a multifactorial aspect that entails various considerations, including the reliability of the results, elimination of bias, validity, appropriateness of the control group, and the randomization process (Melnyk & Fineout-Overholt, 2019). In the identified randomized controlled trial, researchers adhered to multiple elements of quality research. Firstly, they applied a randomization process at the beginning of the study by randomly assigning 106 students to the intervention (n=53) and control groups (n=53). Secondly, the researchers concealed information regarding interventions by “blinding” students and instructors. This strategy profoundly eliminated biases when recruiting participants and prevented placebo effects. Melnyk & Fineout-Overholt (2019) present the placebo effect as a phenomenon where “participants respond to an intervention simply because they received something from the researchers rather than because the intervention itself was effective” (p. 204-205). An unaddressed placebo effect can significantly affect research findings’ quality, reliability, validity, and generalizability.

Besides blinding and randomization processes, researchers adopted precise interventions consistent with the study’s objective. According to Ozan et al. (2019), the intervention group received a clinical education program based on Watson’s theory of human caring. The education intervention focused on various caring moments, including establishing easy and effective communication with instructors, working together in the field of application, opportunities for students to express emotions and thoughts on the issue of concern, and follow-up activities. On the other hand, instructors applied the routine clinical education program to the students in the control group. Further, researchers rotated students across the two groups to prevent ethical problems after the data collection phase. Arguably, these strategies allowed researchers to apply various measurement tools for pre-and post-intervention evaluation of the effect of the clinical education program on anxiety and stress alleviation.

Finally, the study’s findings represented an essential quality aspect since they aligned with randomized controlled trials (RCTs) thresholds. The study revealed a significant difference in anxiety mean scores between the two groups (p<0.001) and the self-confident approach. Also, the intervention group demonstrated a high level of adopting methods for coping with stress compared to the control group (p<0.05) (Ozan et al., 2019). Establishing the statistical significance of intervention is a profound strategy for enhancing the quality of research findings and improving the funding’s generalizability. In this case, it is possible to statistically establish the impact of the clinical education program based on Watson’s theory of human caring on anxiety management and students’ coping capacity to stress.

Rationale

The study supports the application of Jean Watson’s theory of human caring in developing and implementing education programs for people grappling with anxiety and stress. Consistent with Jean Watson’s theory, this study recommends various humanistic approaches to properly implementing education programs. These approaches include building meaningful relationships with students, adopting transpersonal teaching-learning strategies, allowing students to express emotions and thoughts, professional socialization with students, and offering social support to students struggling with anxiety and stress. These strategies align with the Ten Caritas Processes.

Implication for Practice

Based on the findings from the study, it is possible to implement education programs based on Watson’s theory of human caring since it strengthens the humanistic approach. The results revealed that the clinical education program based on Watson’s theory increased students” coping capacity and reduced their anxiety levels. The differences between the intervention and the control group were statistically significant, reflecting the effectiveness of the study’s intervention. Further, the study results were consistent with the current literature that explores the rationale for Jean Watson’s theory in different clinical settings and contexts (Ozan et al., 2019). Therefore, clinicians can apply this theory in informing care plans in psychiatry, primary care, palliative care, and other settings.

Further Research and Evaluation

Although the study results are valid and generalizable, researchers identified some limitations that necessitate further research. Firstly, the study was limited to third-year university students in Eastern Turkey. Therefore, this target population was only partially representative. Secondly, the study involved a relatively small sample (n=102 participants after four students dropped out). The reasons for dropping out of the study included unwillingness to continue the clinical practice and the desire to leave without working. Andrade (2020) argues that a small sample size limits the quality and reliability of study results by having insufficient statistical power to answer research questions. Therefore, the identified limitations necessitate further research on the topic. In this case, researchers should involve a highly representative and relatively large sample to obtain more reliable, valid, and generalizable findings regarding the impacts of education programs based on Watson’s theory on anxiety and stress management.

References

Aghaei, M. H., Vanaki, Z., & Mohammadi, E. (2020). Watson’s human caring theory-based palliative care: A discussion paper. International Journal of Cancer Management, 13(6), 1–6. https://doi.org/10.5812/ijcm.103027

Andrade, C. (2020). Sample size and its importance in research. Indian Journal of Psychological Medicine, 42(1), 102–103. https://doi.org/10.4103/ijpsym.ijpsym_504_19

Melnyk, B. M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing & healthcare: A guide to best practice. Wolters Kluwer Health.

Ozan, Y. D., Duman, M., Çiçek, Ö., & Baksi, A. (2020). The effects of clinical education program based on Watson’s theory of human caring on coping and anxiety levels of nursing students: A randomized control trial. Perspectives in Psychiatric Care, 1–8. https://doi.org/10.1111/ppc.12477

Wei, H., & Watson, J. (2019). Healthcare interprofessional team members’ perspectives on human caring: A directed content analysis study. International Journal of Nursing Sciences, 6(1), 17–23. https://doi.org/10.1016/j.ijnss.2018.12.001

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