NURS 8250 Week 4 Theory Evaluation Paper Example

Criteria It Could Fail: Evaluating Watson's Theory of Human Caring Against Fawcett's Standards, Using Psychiatric Boarding in an Emergency Department

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College of Nursing, Walden University

NURS 8250: Advanced Theoretical and Scientific Perspectives in Nursing

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Month Day, Year

Criteria It Could Fail: Evaluating Watson's Theory of Human Caring Against Fawcett's Standards, Using Psychiatric Boarding in an Emergency Department

Introduction

Judging a theory means applying criteria it could fail. An evaluation that lists a theory's strengths and adds a paragraph of mild concerns has not really evaluated it. This paper evaluates Watson's theory of human caring against the criteria Fawcett and DeSanto-Madeya (2013) set out for nursing theories, six in all, running from significance and internal consistency through parsimony and testability to the two kinds of adequacy, empirical and pragmatic. It uses one problem throughout: adults in a psychiatric crisis held for long hours in the emergency department of a composite community hospital because no inpatient psychiatric bed is available. National data have shown that psychiatric patients are more likely than other patients to board in emergency departments and tend to board longer (Nolan et al., 2015). In this department, a patient may spend a day or more in a hallway bed or a small room, watched by a sitter, while nurses care for the rest of a busy department.

Watson's Claims, Briefly

Watson (2008) treats caring as nursing's highest moral commitment, carried out through transpersonal caring relationships in which the nurse and the patient meet as whole persons. The theory's core concepts include the caring moment, an occasion in which two people come together with the potential for healing, the caritas processes, ten practices that express caring, such as practicing loving-kindness, being authentically present and creating a healing environment, and caring consciousness, the nurse's intention and awareness. The theory is usually classed as a grand theory or philosophy, with explicit spiritual and metaphysical claims.

Significance

Under significance, the evaluator looks for openly stated philosophical commitments and for attention to questions that matter to nursing as a discipline. Watson's theory does well here. Its values are stated clearly, and it addresses something at the center of nursing: how the nurse is present with a suffering person. In the boarding problem, it names what is most at risk. A patient in crisis, held in a hallway for a day, may be treated as a safety problem to be contained rather than a person in distress. The theory's insistence on the whole person gives the evaluation a clear standard for what is missing.

Verdict: met.

Internal Consistency

The second criterion, internal consistency, looks at whether a reader can pin down what each term means, whether that meaning holds steady across the theory and whether the pieces agree with one another. Here the theory is weaker. Terms such as transpersonal, caring consciousness and caritas field are defined in philosophical language that can be read in different ways, and the theory's vocabulary has changed over time, from carative factors to caritas processes. A nurse trying to apply the theory in the emergency department would find it hard to say exactly when a caring moment has occurred or what distinguishes caring consciousness from ordinary attentiveness.

Verdict: partly met. The theory is coherent as a philosophy, but its semantic clarity is limited.

Parsimony

Parsimony rewards economy: the fewest concepts and claims that still do justice to what the theory describes. With ten caritas processes, several core concepts and layers of metaphysical claims, the theory is not parsimonious. For the boarding problem, the complexity matters in practice: a nurse assigned to six patients, one of them a boarding psychiatric patient, cannot enact ten processes with each person in a shift.

Verdict: not met.

Testability

Testability concerns whether anyone could, in principle, gather data that would bear on the theory, by measuring what it names and checking what it predicts. For a grand theory, Fawcett and DeSanto-Madeya (2013) accept a lower standard, asking whether the theory can generate middle-range theories or research. Watson's theory has generated instruments. Brewer and Watson (2015), for example, report on measures used to evaluate caring professional practice, including patient perceptions of caring. But the theory's central claim, that transpersonal caring fosters healing, including at a spiritual level, is difficult to test in the terms of most research designs.

Verdict: partly met. Parts of the theory can be measured; its central metaphysical claims cannot.

Empirical Adequacy

For empirical adequacy, the question is whether studies have borne out what the theory asserts. The theory has a substantial research literature. Smith (2004) reviewed research related to the theory and organized it by focus, including studies describing the nature of caring and studies of caring-based practice. Much of that work describes caring rather than testing whether caring as the theory defines it produces the outcomes it predicts. For psychiatric boarding specifically, there is no evidence that applying Watson's theory changes outcomes such as agitation, restraint use or the patient's experience.

Verdict: partly met. There is research, but little of it tests the theory's propositions directly, and none addresses this problem.

Pragmatic Adequacy

The last criterion, pragmatic adequacy, turns to use: can nurses learn the theory, does it suit the setting and does care get better when it is applied? Many hospitals have adopted Watson's theory as a professional practice model, which shows that it can be taught and embedded in organizations. But the boarding problem tests the theory's fit with a setting designed for speed. The theory offers nothing about staffing, bed availability or safety protocols, the structural conditions that produce boarding. It can guide how a nurse is present with a boarding patient, for example by introducing herself, explaining what is happening and creating a small measure of privacy and calm, but it cannot address why the patient is in the hallway at all.

Verdict: partly met. The theory can shape nurse-patient encounters within the problem but not the problem's causes.

Overall Judgment

Against Fawcett and DeSanto-Madeya's criteria, Watson's theory is strongest on significance and weakest on parsimony, with partial results on the rest. For psychiatric boarding, it names what matters most, the person in crisis being treated as a person, but it is too complex and too abstract to guide a unit-level change on its own. A DNP project on boarding might use Watson's theory as its philosophical orientation, the reason the project matters, while relying on a middle-range theory or a practice framework for design and measurement. That conclusion is only possible because the evaluation allowed the theory to fail some criteria.

References

Brewer, B. B., & Watson, J. (2015). Evaluation of authentic human caring professional practices. Journal of Nursing Administration, 45(12), 622-627. https://doi.org/10.1097/NNA.0000000000000275

Fawcett, J., & DeSanto-Madeya, S. (2013). Contemporary nursing knowledge: Analysis and evaluation of nursing models and theories (3rd ed.). F. A. Davis.

Nolan, J. M., Fee, C., Cooper, B. A., Rankin, S. H., & Blegen, M. A. (2015). Psychiatric boarding incidence, duration, and associated factors in United States emergency departments. Journal of Emergency Nursing, 41(1), 57-64. https://doi.org/10.1016/j.jen.2014.05.004

Smith, M. (2004). Review of research related to Watson's theory of caring. Nursing Science Quarterly, 17(1), 13-25. https://doi.org/10.1177/0894318403260545

Watson, J. (2008). Nursing: The philosophy and science of caring (Rev. ed.). University Press of Colorado.