Applying Watson’s Theory to a Patient’s Case

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Application of a Theoretical Perspective/ Conceptual Framework in the care of the Patient

An evidence-based approach to patient care is critical to effective therapy and treatment. In my work, I can only use scientific methods that guarantee the expected outcome; consequently, as a nurse practitioner, I must always refer to them in an attempt to resolve patient complaints and improve their quality of life. This paper evaluates the applicability of Jean Watson’s theory to the case of a 56-year-old patient, Mr. Washington.

The core of Watson’s theory, or the theory of transpersonal care, is the use of a holistic approach to each patient. As its name makes clear, Watson’s theory assumes care in the interpersonal relationship between the nurse practitioner and patients or their families as the foundation of effective care (Wei et al., 2019). The theory extends the core skills of the nurse practitioner by adding transpersonal care as a moral value that determines the quality of therapy to the need for treatment. In reality, nurse practitioners rarely find time to apply the theoretical knowledge and concepts gained during training; usually, everything is limited to applied tasks, whether it be fulfilling patient requests, prescribing medications, or monitoring treatment. However, Watson, who built her theory on Nightingale’s ideas, allowed herself to modify nursing practice by adding elements of caring, kindness, and compassion (Rosa et al., 2020). The theorist developed curative factors, the fulfillment of which during practice allows the patient to be surrounded by care and creates a confident impression that the patient is valued and vital to those around them.

The practice does not view them as another object of treatment but instead seeks to enhance the experience of interacting with clinical staff. The patient receives basic treatment and becomes an active participant in interpersonal communication with the nurse practitioner, based primarily on a sincere professional desire to share the care. Care, as the most important resource in this theory, is a hard-to-measure and generally subjective factor, but Watson argued that its use increases the patient’s vitality and accelerates the healing processes (Rosa et al., 2020). Such a theory has already demonstrated scientific validity in real patients (Adib-Hajbaghery et al., 2020; Yang et al., 2021). Therefore, its use seems appropriate for Mr. Washington’s patient.

Mr. Washington is a 56-year-old male of African American descent, a middle manager. In relationships, Mr. Washington is monogamous and has a thirty-year marriage with a wife and three daughters. Mr. Washington’s family anamnesis revealed a predisposition to cardiovascular disease, high blood pressure, and diabetes. Based on the information gathered, it appears that the use of Watson’s theory with respect to Mr. Washington is an effective strategy for several reasons. The person-centered model of care provides a holistic approach, which means that the nurse practitioner does not focus solely on prescribing medication but rather works comprehensively with the patient’s emotional state. It is argued that the patient suffers from chronic stress related to both a high workload and the fear of losing insurance due to job loss. Watson’s theory may have practical value if we try to apply it to this problem, as it is likely to help the patient reduce perceived stress levels. This could be either regular communication, which is usually sufficient, or counseling by psychologists to help resolve Mr. Washington’s inner conflict.

Meanwhile, the patient’s therapeutic status should be considered when choosing treatment and communication strategies. Although the examination findings demonstrate that the patient is generally healthy and has even been vaccinated by Moderna, many of the most important tests and screenings were not performed on Mr. Washington. Thus, Watson’s theory identifies the need to follow clinical prescriptions not from a position of obligation but from the perspective of the patient’s personal benefit and concern for their health. The nurse practitioner points to the need to undergo screenings and monitor the health more closely because it is crucial to improving the patient’s quality of life; fewer illnesses will bother Mr. Washington later, which means there will be more free time to devote to favorite activities, including bowling.

In addition, using Watson’s theory will help to improve patient satisfaction with clinical care qualitatively. Research shows that patient satisfaction is integral to treatment effectiveness (van Zuuren et al., 2021). Meanwhile, the transpersonal model of care has been shown to be associated with increased satisfaction (King et al., 2019). Thus, a more engaged Mr. Washington is more likely to follow lifestyle, diet, and medication prescriptions, which means better treatment outcomes.

In reviewing the anamnesis and extracting key points from it, I can put Watson’s theory into practice in Mr. Washington’s case. A holistic approach to treatment ensures that all possible aspects of the patient’s social and physical health are addressed. For example, it is well known that African Americans are most vulnerable to cardiovascular disease, which increases a patient’s risk of impaired quality of life (Lutz, n.d.). As a consequence of eating unhealthy foods, these patients have an increased risk of developing hyperlipidemia, obesity, and atherosclerotic disease — this applies in Mr. Washington’s case, as we can understand from the examination findings. Applying the concepts of Watson’s model, the nurse practitioner also provides emotional care to the patient, listening carefully to requests and interests.

Watson’s theory implies that I, as a nurse practitioner, am a direct participant in therapy; this means that I need to share my own emotions and concerns about the patient’s treatment. The nurse practitioner needs to share doubts about the patient’s being overweight being a barrier to recovery. The specific language might include, “Mr. Washington, I see your concern and the determination with which you want to overcome the problem of high blood pressure and stress, but your excess weight may prevent us from doing so. So I suggest some rules for your diet…”. With a phrase like this, I demonstrate my interest in therapy.

According to the examination findings, Mr. Washington really needs to change his diet because the patient now has an excess of fats and starchy foods, as well as alcohol. Mr. Washington’s case is far from alcoholism, but the constant stress at work and social tension can lead to the development of this condition (NIH, 2020). From a caring theory perspective, the nurse practitioner recommends a new diet to the patient and shares her thoughts about it. It is important to give the impression that I am genuinely interested in Mr. Washington. This can be stimulated by advice about how hard it is to give up junk food or alcohol but how important it is to do so. Including some personal advice and guidance will also increase Mr. Washington’s involvement and promote effective treatment.

I suggested several treatment options in Mr. Washington’s case study, depending on the presumptive diagnosis and the overall dynamic. These included not only prescribing medications but also lifestyle changes so as to increase physical activity and reduce junk food intake. In addition, I suggested that the patient undergo five types of screenings to get a more comprehensive profile of Mr. Washington’s health status. I expect these activities to be appropriate and effective for therapy; however, I see several potential barriers that may prevent the application of Watson’s theory. First, we do not know the patient’s history of athletic activity since no sports have been reported other than a regular trip to the bowling alley. If I suggest that Mr. Washington increase the amount of physical activity through, for instance, walking outdoors or doing cardio exercises, I cannot be sure that the patient will perform them honestly. Second, the same applies to the diet I suggested for Mr. Washington: avoid fatty foods and switch to fruits and vegetables. Again, I cannot be sure that the patient will comply with my prescriptions because eating habits — especially junk food — are extremely strong. Thus, there are potential barriers to compliance with the treatment plan, which will obviously have a negative effect on the effectiveness of the therapy as a whole.

Application of Ethical, Economic and Nurse Practitioner Practice principles in the care of the Patient

An integral part of the nurse practitioner’s work is the precise adherence to ethical principles that predetermine the relationship with all stakeholders in treatment, whether patient or family. One such theoretical framework for medical ethics is deontology, as the science of communication between the clinical professional and the patient to improve the quality of care and encourage more effective treatment (Silva et al., 2018). Among the fundamental principles of deontology are the unconditional respect of the nurse practitioner for the patient, tactfulness and politeness in communication, and maintaining medical confidentiality with collegiality; without it, the therapy cannot be of good quality. In other words, deontology defines the culture of the nurse practitioner, which seeks to ensure caring and benevolent communication by placing prohibitions on violations of professional ethics.

The applicability of clinical deontology to Mr. Washington’s case is also a significant practice. Mr. Washington shared personal information with health care providers that included detailed descriptions of lifestyle, diet, and work stress and predispositions to hereditary diseases and personal issues. In addition, Mr. Washington voluntarily submitted all tests and provided me with these results. It is unlikely that any patient would ever want to share personal information with a third party. Therefore, in this case, the fundamental principle of ethics that works is based on the rule of confidentiality; Mr. Washington must be unconditionally assured that personal information will not be published or shared with third parties without consent. Even if the information is used for research purposes, the nurse practitioner must use measures to anonymize or pseudonymize the data to protect Mr. Washington’s identity. It works on the other side, too; I need to be sure that the information being reported is accurate and that Mr. Washington has not tried to embellish any data so as not to feel guilty or biased. A patient may not fully trust me or withhold some of the information that is helpful to the overall treatment — certainly this would be devastating to the clinical process. Only with a balance of honesty and confidentiality as fundamental principles of deontology is there a positive opportunity for effective treatment.

In addition, in Mr. Washington’s case, patient care is crucial. At first glance, the lack of a chronic illness may somewhat diminish the importance of this case, as 47% of Americans already suffer from high blood pressure, and Mr. Washington may be perceived as another one of them (CDC, 2021). However, the nurse practitioner’s code of ethics states that every patient is different and cannot be seen as just another. Recognizing and understanding this principle plays a constructive role in ensuring honesty and participation; when a patient feels they are truly cared for, Mr. Washington is more likely to share their doubts and concerns. The patient must be convinced that the code of ethics certainly works and no exceptions or biases are allowed.

As we know, nurse practitioner ethics are based on looking out for the patient’s best interests, so a holistic approach must be taken. Because every clinical case is different, treatment processes and communication with the patient must be based on personal interests and requests. In particular, as examination findings show, Mr. Washington’s diet is excessive on junk food and alcohol. A reasonable strategy would be to advise to abandon such a diet, but it is unlikely that the patient could easily accept it. From this point of view, a holistic approach would consider Mr. Washington’s interests and would not suggest a completely substituted diet but would make changes gradually. The expectation is that this approach could lead to positive changes and an upturn in motivation for treatment.

In providing clinical services, the interests of the patient must also come first. In Mr. Washington’s case, I could not identify any explicit interests or expectations, so I can only speculate what the requests might have been. For example, if Mr. Washington asked me not to inform the family of the visit, this should have been a priority for me at all times unless critical conditions arose (FindLaw, 2018). If Mr. Washington expressed a desire to use specific medications, I should have gone along with it, as it reflects a desire to adapt to the individual case and show concern for the best interests of the patient. Such displays of nursing ethics, in turn, increase patient involvement and interest in treatment.

Nurse practitioners should use several vital principles based on a synthesis of the pursuit of the best care, ethics, and the patient’s interests in their decision-making. The study of ICD-10 disease codes should assist in finding medications that are both beneficial and encouraged by Mr. Washington. In particular, if a patient has a serious bias against a particular medication and tells me so, I should have either elaborated on it or suggested several similar medications on the market — in any case, to meet the patient’s needs. This reflects the individuality of the clinical approach in actually addressing the clinical problem of high blood pressure.

Examining ICD codes for presumptive diagnoses will allow for a more detailed understanding of each condition’s possible risks and consequences. As you know, ICD codes are used to systematize clinical language; thus, studying them will enhance my experience and discuss most aspects of presumptive diagnoses with the patient. In this case, Mr. Washington can decide which problem to address first, and if I agree to such a revise will reassure the patient and bring clarity to the therapy. Ethically, this move would reflect me as an open-minded and open to new science-based knowledge as a nurse practitioner.

Meanwhile, a nurse practitioner’s job is to keep a patient’s skills and knowledge up to date, which is an important part of the overall treatment. Training is accomplished through conversations and coaching, during which I share my professional experience and recommendations with the patient. Many of the treatment plans offered for Mr. Washington focus on lifestyle changes, and such changes require training. I have to give regular educational talks and talk about the possibilities for systematic, painless changes. For example, eliminating fatty pork from the diet cannot be done instantly, so Mr. Washington can be encouraged to make a smooth transition by reducing his weekly red meat intake and replacing it with vegetables (Strong, 2021). I must train the patient to take the medication correctly and read the instructions carefully to avoid making mistakes. This skill training is expected to be successful because Mr. Washington self-referred to me, which means that the patient is concerned about health and is willing to work on it.

As a nurse practitioner, I must be as inclusive as possible in my work. This facet of professional ethics means that I must remain open-minded and cultivate the importance of individualizing my patients, encouraging them to share their perspectives, and giving them opportunities to learn. One of the essential features of inclusiveness is also the development of a sense of belonging for the patient. I expect to be able to apply these practices in Mr. Washington’s case as well. Specifically, I will use conversation as a form of prompting activity in which I ask the patient to share feelings and express doubts. For example, I might use the following wording: “What do you think about this?” or “What do you think the problems might arise in using this practice?” It seems that questions like these will help engage the patient in the treatment process and increase overall interest in the outcome. Inclusivity, however, also means encouraging decision-making; hence, I have to create an environment in which Mr. Washington has choices and is not limited by the options I offer. In order to realize this, I might use a form of discussion in which I ask the patient to talk about a possible vision for overall treatment and what measures seem helpful and really effective to Mr. Washington. I expect these decisions to be beneficial primarily as measures to encourage the patient to participate in therapy voluntarily and not to feel that nothing depends on Mr. Washington’s wishes. Ultimately, therapy only becomes beneficial and effective when the patient not only complies with the nurse practitioner’s orders but also feels a sense of belonging in the process.

References

Adib-Hajbaghery, M., Bolandianbafghi, S., & Nabizadehgharghozar, Z. (2020). Implementation of Watson’s theory in a patient with breast cancer: A case study. Advances in Nursing & Midwifery, 29(1), 1-7. Web.

CDC. (2021). Facts about hypertension. CDC.

FindLaw. (2018). Can doctors share patient information without permission?FindLaw.

King, C., Rossetti, J., Smith, T. J., Raison, M., Gallegos, D., Gorman, R.,… & Watson, J. (2019). Effects of a mindfulness activity on nursing service staff perceptions of caring behaviors in the workplace. Journal of Psychosocial Nursing and Mental Health Services, 57(11), 28-36.

Lutz, R. (n.d.). Health disparities among African-Americans. Pfizer.

NIH. (2020). Drinking levels defined. NIAAA. Web.

Rosa, W. E., Dossey, B. M., Koithan, M., Kreitzer, M. J., Manjrekar, P., Meleis, A. I.,… & Watson, J. (2020). Nursing theory in the quest for the sustainable development goals. Nursing Science Quarterly, 33(2), 178-182.

Silva, T. N. D., Freire, M. E. M., Vasconcelos, M. F. D., Silva Junior, S. V. D., Silva, W. J. D. C., Araújo, P. D. S., & Eloy, A. V. A. (2018). Deontological aspects of the nursing profession: understanding the code of ethics. Revista Brasileira De Enfermagem, 71, 3-10.

Strong, R. (2021). Side effects of giving up red meat, according to science. Eat This, not That.

van Zuuren, E. J., Arents, B. W. M., Miklas, M., Schoones, J. W., & Tan, J. (2021). Identifying and appraising patient‐reported outcome measures on treatment satisfaction in acne: a systematic review. British Journal of Dermatology, 185(1), 36-51.

Wei, H., Fazzone, P. A., Sitzman, K., & Hardin, S. R. (2019). The current intervention studies based on Watson’s theory of human caring: A systematic review. International Journal for Human Caring, 23(1), 4-22.

Yang, S., Guo, W., Gong, Y., Wang, J., Chen, L., Zhao, J.,… & Song, Y. (2021). Application of vitamin A palmitate eye gel and nurse value of Watson’s theory of caring in children with dry eye after strabismus surgery: A randomized trial.Translational Pediatrics, 10(9), 2335-2346.

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Applying Watson’s Theory to a Patient’s Case

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