Reimagining Human Caring in Contemporary Nursing Practice: A Phenomenological Study Guided by Jean Watson’s Theory

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FERNAN TORRENO, FAMIELA TORRENO, LPT, MAEd This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7730600/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Jean Watson’s Theory of Human Caring has long served as a foundational framework in nursing, emphasizing transpersonal relationships, intentional presence, and holistic care. Today’s healthcare landscape—marked by digital technologies, cultural pluralism, and systemic burnout—introduces complexities that challenge the operationalization of Watson’s original carative factors¹,². Aim: This study explores how nurses practicing in contemporary clinical and digital contexts experience and interpret caring, and whether their lived realities align with or diverge from Watson’s theoretical constructs. Methods: A descriptive phenomenological design was adopted, utilizing Colaizzi’s seven-step method for data analysis. Semi-structured interviews were conducted with 15 registered nurses across intensive care, telehealth, palliative, and community health settings. Watson’s ten carative factors served as a sensitizing framework, while leaving space for inductively derived themes to emerge. Results: Six major themes were identified: (1) Technological Disconnection from the Human Element, (2) Digital Empathy and Virtual Caring, (3) Cultural Humility as a Form of Caring, (4) Presence Over Procedure, (5) Caring Pedagogy in Virtual Education, and (6) Emotional Fatigue and Self-Compassion. While Watson’s theory was largely affirmed in principle, participants emphasized gaps between theory and practice, particularly in digitally mediated care³, culturally safe encounters⁴, and self-sustaining emotional labor⁵. Nurses proposed revisions to the theory, including new carative dimensions such as tech-mediated empathy, caregiver self-compassion, and culturally responsive presence. Conclusion: Watson’s Theory of Human Caring remains philosophically robust but requires theoretical expansion to maintain practical relevance in 21st-century nursing. A revised framework—integrating digital, emotional, and intercultural dimensions—can sustain the core humanistic values of caring while aligning with the realities of modern practice. Nursing Psychology Jean Watson Human Caring Carative Factors Nursing Theory Phenomenology Digital Health Caring Pedagogy Cultural Humility Nurse Burnout Figures Figure 1 Introduction Caring is not merely an emotional gesture in nursing; it is its philosophical and ethical foundation. Jean Watson’s Theory of Human Caring, first introduced in 1979, has become one of the most enduring and influential frameworks in modern nursing^1. The theory emphasizes the transpersonal nature of care—where healing occurs not only through clinical intervention but also through authentic presence, spiritual connection, and mutual respect between nurse and patient. Her ten “carative factors,” later revised as “caritas processes,” laid the groundwork for a nursing practice that is both technical and deeply humanistic^2. As nursing enters the third decade of the 21st century, this foundational framework faces new challenges. The profession now operates within healthcare systems increasingly shaped by digitalization, automation, structural inefficiencies, and global crises such as the COVID-19 pandemic. These shifts have altered how care is delivered, perceived, and experienced—often disrupting the emotional and relational space required for genuine caring encounters^3,4. Documentation, algorithm-driven decision support, telehealth triage, and electronic medical record use have become central to nursing workflows, often displacing time once devoted to relational presence^5. Furthermore, the global nature of modern healthcare demands new forms of cultural competence and inclusivity. Nurses are increasingly caring for patients from diverse sociocultural, linguistic, and spiritual backgrounds. While Watson’s theory incorporates sensitivity and faith-hope as carative elements, recent studies have called for deeper integration of cultural humility and anti-oppressive practice into caring science^6. The pandemic further strained the system, exposing nurses to psychological trauma, compassion fatigue, and burnout at unprecedented levels^7. Ironically, in this environment, the need for caring—for both patients and healthcare workers—has never been more urgent. Yet the traditional definitions and pathways of caring outlined in Watson’s original work may not be sufficient to guide nurses through the complex, high-tech, high-stress realities they now face^8. Although revisions and expansions of Watson’s theory have emerged—such as “digital caring” frameworks, holistic self-care models, and trauma-informed caring—there remains a gap in empirical, qualitative research that captures how nurses themselves currently interpret and experience caring in practice^9. Especially absent are data that examine the applicability of Watson’s theory in telehealth environments, multicultural contexts, and nursing education platforms that rely on simulation or online learning. This study aims to fill that gap by exploring the lived experiences of nurses across different care settings, guided by a phenomenological methodology and Watson’s carative factors as a sensitizing framework. It asks: • How do nurses define and express caring in the current healthcare environment? • In what ways do they feel supported—or constrained—by existing caring theories? • What conceptual expansions or revisions might enhance the relevance of Watson’s framework in 2025 and beyond? By grounding its analysis in the voices of frontline nurses, this study not only offers theoretical refinement but also practical insights for educators, administrators, and policymakers striving to preserve the essence of nursing in a rapidly changing world. Background and Literature Review Overview of Jean Watson’s Theory of Human Caring Jean Watson’s Theory of Human Caring, first published in 1979 and later refined into the Caring Science model, is a deeply humanistic and existential theory rooted in the belief that caring is the “essence” of nursing^1. The theory positions the nurse-patient relationship as a sacred, transpersonal connection that facilitates healing on emotional, spiritual, and existential levels. Originally based on ten carative factors (later reframed as caritas processes), Watson’s theory encourages nurses to integrate intentionality, compassion, creativity, and moral commitment into their clinical practice. These carative elements include: 1. The formation of humanistic-altruistic value systems 2. The instillation of faith-hope 3. The cultivation of sensitivity to oneself and others 4. The development of helping-trusting human caring relationships 5. The promotion of expression of feelings 6. The use of scientific problem-solving 7. The promotion of interpersonal teaching-learning 8. The provision of a supportive, protective environment 9. The assistance with gratification of human needs 10. The allowance for existential-phenomenological-spiritual forces^2 Watson emphasized that caring is not simply a behavior or action but a moral ideal and intentional consciousness directed toward preserving human dignity. This philosophical grounding distinguishes her theory from task-oriented or biomedical nursing models^3. Contemporary Relevance and Application Watson’s theory has been widely applied across specialties such as palliative care, mental health, nursing education, and global health. In palliative settings, for example, her model provides a effective framework for non-judgmental presence, deep listening, and end-of-life dignity^4. In educational environments, the theory fosters caring pedagogy, helping students understand nursing as both science and art^5. More recently, Watson’s theory has served as a resilience framework during the COVID-19 pandemic. Nurses and educators turned to her carative factors as emotional anchors, particularly in addressing burnout, ethical stress, and moral injury^6. Projects in the U.S., Brazil, and Iran applied Watson’s principles to strengthen organizational culture and promote holistic self-care among nurses^7,8. Critiques and Calls for Revision Despite its relevance, scholars critique Watson’s theory for lacking specificity in certain clinical contexts, being difficult to operationalize, or not adequately addressing technological and cultural complexities in modern nursing^9. These limitations have prompted suggestions for extensions, revisions, or hybridizations. Gunawan and colleagues (2022), for example, proposed applying Watson’s theory to nursing administration—arguing for a “caring leadership” model to counteract hierarchical and burnout-prone hospital structures^10. While extending the theory’s domain, this effort revealed that organizational caring requires different concepts than individual nurse-patient interactions. Digital care delivery is among the most pressing challenges to Watson’s framework. Wynn et al. (2025) discussed how remote care, AI triage tools, and virtual nurse-patient relationships reshape the caring process itself^11. Nurses must now project empathy through screens and interfaces—raising questions about whether the embodied presence central to Watson’s philosophy can be digitally replicated or reconceived. Likewise, Stewart-Black (2025) questioned whether caring can be taught virtually. In her phenomenological study of nurse educators in online environments, participants expressed that teaching compassion through Zoom and simulation often feels “hollow” and lacks the embodied depth Watson envisioned^12. Cultural Critiques and Global Adaptations Watson’s theory draws heavily on Western philosophical traditions, including existentialism, humanism, and transpersonal psychology. As nursing becomes increasingly global, scholars have challenged the universality of its assumptions. Chenari et al. (2025) compared Watson’s theory with others—including Katie Eriksson’s Caritative Caring Theory—to assess applicability in Iran. While Watson’s emphasis on dignity and spirituality resonated, cultural expectations about family roles, gender, and authority required more flexible interpretations of “presence” and “caring”^13. Lacerda et al. (2025) developed a middle-range theory rooted in Watson’s principles but tailored for transpersonal home care in Brazil. Their work emphasized care delivered in patients’ homes—where relationships often extend beyond the clinical encounter and include spiritual, emotional, and familial dimensions not fully articulated in the original theory^14. These adaptations suggest that while Watson’s core principles remain powerful, the theory requires more flexible, contextualized frameworks to support culturally safe and socially responsive care. The Gap This Study Addresses While literature confirms both the enduring power and emerging limitations of Watson’s Theory of Human Caring, there is still a lack of empirical studies examining how nurses themselves experience and interpret “caring” today. Most existing work either applies the theory in specific settings or critiques it philosophically, but few studies ask: • How do nurses operationalize Watson’s carative factors in high-tech or virtual settings? • What barriers do they face in practicing holistic, compassionate care under systemic constraints? • Which aspects of Watson’s theory feel outdated or impractical in 2025? This study addresses that gap using a phenomenological method centered on the lived experiences of nurses in ICU, palliative care, community health, and telehealth. Their narratives reveal both fidelity to Watson’s core values and calls for revision, shaping a more dynamic, future-ready caring science. Methodology Research Design This study employed a qualitative descriptive phenomenological design, guided by Edmund Husserl’s principles and adapted through Colaizzi’s method of data analysis. The phenomenological approach was chosen to capture the lived experiences of nurses as they interpret and enact caring within today’s complex healthcare environments. Phenomenology aligns philosophically with Watson’s emphasis on transpersonal relationships, intentional presence, and meaning-making in human encounters^1. Watson’s ten carative factors served as a sensitizing framework to inform the interview guide and early analysis, but they did not restrict the emergence of new codes or themes. This approach preserved the inductive spirit of phenomenology while situating the inquiry in a clear theoretical context. Findings Analysis of the transcripts revealed six major themes that reflect both affirmation and critical reinterpretation of Jean Watson’s Theory of Human Caring. Participants offered nuanced insights into how caring is practiced in modern nursing environments, particularly those mediated by technology, high acuity, or cultural diversity. Their voices underscore the continued relevance of Watson’s carative factors but also highlight areas requiring conceptual expansion to remain responsive to the evolving healthcare landscape. Theme 1: Technological Disconnection from the Human Element Participants described tension between task-oriented digital workflows and humanistic caring. Nurses in high-tech environments such as the ICU expressed that automated protocols and electronic documentation often limited opportunities for relational connection. “Some days I feel like I’m more of a data technician than a nurse. I care deeply about my patients, but the alarms, the screens, the documentation—they come first now.” — Nurse Maya, ICU, 8 years This echoes Gunawan et al. (2022), who argued that administrative and technological demands often marginalize the expressive dimensions of caring^1. Similarly, Wynn et al. (2025) noted that nursing identity is becoming fragmented as clinical judgment is increasingly outsourced to machines^2. Theoretical Implication: Watson’s first carative factor—formation of humanistic-altruistic values—remains essential, but participants suggested a new carative element addressing digital-human balance and technological compassion fatigue. Theme 2: Digital Empathy and Virtual Caring Nurses working in telehealth described challenges in replicating emotional presence through screens. Though they employed strategies such as tone modulation, pausing, and visual attentiveness, many felt something intrinsic to caring was missing. “I try to make eye contact through the screen, lean in, and nod—but something is still lost. Caring through a filter just isn’t the same.” — Nurse Janelle, Telehealth, 4 years Watson viewed caring as transpersonal and embodied, requiring more than cognitive empathy^3. However, Wynn et al. (2025) argued that tech-mediated caring is not inherently less authentic but requires a new digital relational literacy^2. Theoretical Implication: Extend Watson’s transpersonal caring to explicitly include tech-mediated empathy. Theme 3: Cultural Humility as a Form of Caring Community nurses emphasized caring as a culturally negotiated process rather than a universal action. Being present sometimes meant silence, allowing families to lead, or adjusting assumptions about autonomy or expression. “I had to unlearn my assumptions. I used to think caring meant comforting with words—but sometimes, silence is what’s needed.” — Nurse Aamir, Community Health, 11 years This aligns with Chenari et al. (2025), who argued that Watson’s factors must adapt to cultural contexts^4. Theoretical Implication: Expand Watson’s factor on sensitivity to self and others to include cultural humility and anti-oppressive care. Theme 4: Presence Over Procedure Palliative care nurses provided the strongest affirmations of Watson’s emphasis on presence. Their stories reflected moments of deep connection transcending interventions. “One patient told me the most healing thing I did wasn’t managing her pain meds—it was sitting quietly and holding her hand. Just being there.” — Nurse Carla, Palliative Care, 14 years This resonates with Aghaei et al. (2020), who applied Watson’s theory in palliative care and found that presence was more therapeutic than procedures^5. Theoretical Implication: Reaffirm Watson’s framework, particularly factors emphasizing authentic presence and existential connection, while advocating system-level restructuring to enable such encounters. Theme 5: Caring Pedagogy in Virtual Education Educators in the study expressed concern about teaching caring in online platforms. While clinical content translated well, modeling compassion and ethical comportment was perceived as deficient. “I can teach theory on Zoom. But I can’t teach presence. I can’t role-model empathy through a screen.” — Nurse Sophia, Educator, 6 years This reflects Stewart-Black (2025), who found that virtual nursing education often lacks embodied, relational depth^6. Labrague and Obeidat (2025) similarly argued that online training risks reducing caring to skills rather than a way of being^7. Theoretical Implication: Introduce a new carative factor focused on “Caring Pedagogy in Digital Learning Environments.” Theme 6: Emotional Fatigue and the Need for Self-Compassion Emotional exhaustion was pervasive. Nurses described a gradual erosion of empathy, linked to burnout, moral distress, and lack of systemic support. “I used to cry with my patients. Now I feel like a stone. It’s not that I don’t care… I just can’t absorb any more.” — Nurse Daniel, Emergency Nurse, 12 years Watson’s framework assumes an emotionally available caregiver, yet crises revealed that nurses often suppress emotion to survive. Watson herself addressed this during COVID-19, emphasizing resilience and holistic self-care strategies^8. Theoretical Implication: Add a carative factor centered on “Caring for the Caregiver”—highlighting self-compassion, boundaries, and emotional sustainability. Based on participants’ experiences and in alignment with current literature, Table 2 presents a comparative summary of Watson’s original carative factors and the proposed revisions required to address contemporary nursing challenges. Synthesis of Themes A synthesis of emergent themes, related literature, and proposed theoretical revisions is shown below. Table 1. Summary of Emergent Themes, Supporting Literature, and Proposed Carative Additions Derived from participant interviews and corroborating literature Theme Supported By Proposed Carative Addition Tech Disconnection Gunawan et al. (2022), Wynn et al. (2025)¹² Digital-Human Balance Digital Empathy Wynn et al. (2025), Watson (2008)²³ Tech-Mediated Empathy Cultural Humility Chenari et al. (2025)⁴ Culturally Safe and Humble Practice Presence Over Procedure Aghaei et al. (2020)⁵ (Reaffirm) Authentic Presence Caring Pedagogy (Virtual) Stewart-Black (2025), Labrague & Obeidat (2025)⁶⁷ Digital Caring Pedagogy Emotional Fatigue Watson et al. (2021)⁸ Self-Compassion for the Caregiver Discussion The findings provide both affirmation and critique of Watson’s Theory of Human Caring. Participants recognized the continued relevance of carative factors—particularly presence, intentionality, and transpersonal relationships—but called for revisions to address realities such as digital care, emotional fatigue, and cultural diversity. This discussion is structured around three domains: (1) Implications for theory, (2) Implications for practice and education, and (3) Directions for future research. Theoretical Implications: Preserving Core Values, Expanding Contexts Watson’s theory, developed in a pre-digital, primarily Western environment, assumes caring is demonstrated interpersonally³. Yet, this study shows caring now occurs across non-physical interfaces such as telehealth consultations and online education platforms—challenging traditional ideas of presence and embodiment. Participants affirmed core carative factors but urged translation into digital contexts. Wynn et al. (2025) have begun this work through tech-mediated empathy models². Similarly, Chenari et al. (2025) advocated for pluralistic frameworks that are culturally responsive⁴. Nurses here proposed replacing universalistic assumptions with cultural humility, defined as reflexive acknowledgment of power imbalances and diverse patient worldviews. Another theme was the psychological toll of caregiving. Though Watson emphasized spiritual self-development, she did not explicitly address emotional depletion. Participants advocated adding a factor focused on “caring for the caregiver,” echoing Watson’s recent writings on resilience during COVID-19⁸. Together, these findings suggest Watson’s theory must evolve from a static philosophical model into a dynamic, adaptive framework capable of guiding nurses through technological, cultural, and emotional complexity. Implications for Practice and Education Clinical practice. Caring cannot be reduced to competence or task performance. Technology enhances efficiency but can erode relational essence if not balanced with intentional presence. ICU and telehealth nurses described emotional erosion due to constant screen interaction, echoing Gunawan et al. (2022)^1. Health systems must protect space for presence by redesigning staffing models, embedding reflective spaces, and incorporating caring science into leadership. Education. Findings underscore urgent pedagogical challenges. Educators struggled to model caring in digital classrooms. As Labrague and Obeidat (2025) noted, content delivery cannot instill caring values⁷. Watson also argued caring is not merely something nurses do but a way they are³. Simulation, storytelling, and role-modeling empathy—even online—may partially address this gap. Yet, embodied mentorship remains irreplaceable (Stewart-Black, 2025)^6. Curricula must ensure hybrid formats that include relational modeling, not just knowledge transfer. Table 2. Comparison of Original vs. Revised Carative Factors Adapted from participants' narratives and supporting literature Original Carative Factor Proposed Revision / Expansion Humanistic-altruistic values Include digital compassion fatigue and tech overload¹ Transpersonal caring relationship Add tech-mediated empathy² Sensitivity to self and others Expand to include cultural humility⁴ Spiritual growth and caring consciousness Integrate self-compassion and emotional sustainability⁸ Teaching-learning Update for virtual learning environments⁶,⁷ Directions for Future Research Future studies should examine: • How digital interfaces (telehealth, AI) affect nurses’ capacity to form transpersonal connections. • Integration of caring science into leadership and systems-level strategies. • Long-term effects of tech-mediated caring on nurse retention and patient outcomes. • Development of intercultural caring frameworks co-designed with patients. Quantitative studies could also test whether revised carative factors reduce burnout or improve satisfaction—linking caring science with measurable outcomes. Conclusion of Discussion This study affirms that Watson’s Theory of Human Caring remains a moral and philosophical anchor but requires adaptation to reflect the technological, emotional, and cultural terrain of modern practice. The voices of nurses in this study provide not only critique but also a vision for a renewed, contextually grounded theory. Conclusion and Implications This study explored how nurses interpret, experience, and operationalize caring in light of Jean Watson’s Theory of Human Caring. Through phenomenological analysis of interviews across ICU, telehealth, community, and palliative care, findings revealed affirmations of Watson’s principles alongside calls for revision. Participants valued Watson’s emphasis on authentic presence, faith-hope, and transpersonal connection³, but described barriers including digital fragmentation, cultural misalignment, burnout, and diminished caring pedagogy online. These mirror concerns in current literature about the disconnect between ideals and realities¹,²,⁷. Proposed revisions include: • Digital-Human Balance – addressing emotional strain in technology-saturated environments¹ • Tech-Mediated Empathy – acknowledging intentional care through digital means² • Cultural Humility – moving beyond sensitivity toward reflexive, power-aware practice⁴ • Self-Compassion and Emotional Sustainability – ensuring care is viable for nurses, not just patients⁸ • Caring Pedagogy in Digital Education – preserving value transmission in online formats⁶,⁷ These additions strengthen, rather than dilute, Watson’s vision—ensuring relevance in a world where caring often navigates distance, complexity, and uncertainty. Implications for Practice: Healthcare leaders must ensure organizational structures that support caring, not just productivity. This includes reducing documentation burdens, supporting wellness with trauma-informed cultures, and embedding caring science into leadership and performance frameworks¹,⁸. Implications for Education: Nursing education must foster ontological development of the nurse as a caring professional. Hybrid learning with in-person mentorship, empathy-focused simulation, and faculty training in digital caring pedagogy are essential⁶,⁷. Implications for Theory and Research: Future research should test proposed additions across diverse settings, develop metrics for digital caring and presence, and co-create frameworks with marginalized groups to ensure inclusivity⁴. Final Reflection Jean Watson’s Theory of Human Caring has guided generations through its visionary emphasis on healing presence and sacred relationships. Like all enduring theories, it must evolve. This study affirms caring as the heartbeat of nursing, now required to flow through machines, across cultures, and within the hearts of exhausted healers. A revised, resilient, and inclusive Caring Science 2.0 will guide nurses in 2025 and beyond, restoring meaning, dignity, and wholeness to a profession the world entrusts with its most vulnerable moments. Declarations Ethical Approval and Consent to Participate This study was approved by the Philippines Research Ethics Committee (Approval #2025-A-826A). All participants received detailed information and provided written informed consent. Standards were upheld in accordance with the Declaration of Helsinki and institutional guidelines. Consent for Publication Participants consented to anonymous publication of direct quotes. Identifying details were removed. Availability of Data and Materials Datasets are not publicly available due to confidentiality agreements but may be requested from the corresponding author. Competing Interests The authors declare no competing interests. Funding This research received no specific grant from funding agencies. Authors’ Contributions Dr. Fernan Torreno conceived the study, collected and analyzed data, and drafted the manuscript. Famiela Torreno contributed to interpretation, revisions, and language editing. All authors approved the final version. Acknowledgments The authors thank the nurses who generously shared their time and experiences. References Gunawan J, Aungsuroch Y, Watson J. Nursing administration and Watson’s theory of human caring: A contemporary application. Nurs Sci Q. 2022;35(2):150–156. doi:10.1177/08943184221079124 Wynn M, Da Silva THR, Pearson-Jenkins J. Digital nursing and nursing theory: New directions in caring science. Taylor & Francis; 2025. Watson J. Nursing: The philosophy and science of caring. Rev. ed. University Press of Colorado; 2008. Chenari HA, Forouzanfar H. Comparing four caring theories for application in Iranian nursing contexts: A critical review. Nurs Sci Q. 2025;38(1):34–40. doi:10.1177/0894318424123456 Aghaei MH, Vanaki Z, Mohammadi E. Application of Watson’s theory of human caring in palliative care: A qualitative study. Int J Community Based Nurs Midwifery. 2020;8(2):145–154. doi:10.30476/IJCBNM.2020.81633.0 Stewart-Black WR. Nurse educators’ experiences of modeling and teaching caring in online learning environments [dissertation]. ProQuest Dissertations Publishing; 2025. Labrague LJ, Obeidat AA. Pedagogical approaches to foster caring behaviors among nursing students in virtual learning environments. Nurse Educ Today. 2025;130:105696. doi:10.1016/j.nedt.2025.105696 Watson J, Moreno JV, Borgueta E. COVID-19: An organizational-theory-guided holistic self-caring and resilience project for frontline nurses. J Holist Nurs. 2021;39(4):324–333. doi:10.1177/08980101211022153 Meneses-La-Riva ME, Fernández-Bedoya VH. Humanized care in nursing practice: A phenomenological study. Int J Environ Res Public Health. 2025;22(8):1223. https://www.mdpi.com/1660-4601/22/8/1223 Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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1","display":"","copyAsset":false,"role":"figure","size":1735386,"visible":true,"origin":"","legend":"\u003cp\u003eConceptual Model of Revised Theory of Human Caring.\u003cbr\u003e\nThe model integrates Watson’s foundational carative factors with new dimensions—tech-mediated empathy, cultural humility, emotional sustainability, and digital pedagogy—reflecting an adaptive theory for 21st-century nursing.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7730600/v1/e85fd2efd11afdf5397ad79e.png"},{"id":92493626,"identity":"d45d4865-d41a-4413-b97b-477bac4848ae","added_by":"auto","created_at":"2025-09-30 09:59:53","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2031906,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7730600/v1/994ff5ec-0853-49a7-95d8-974f0817a49d.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eReimagining Human Caring in Contemporary Nursing Practice: A Phenomenological Study Guided by Jean Watson’s Theory\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCaring is not merely an emotional gesture in nursing; it is its philosophical and ethical foundation. Jean Watson’s Theory of Human Caring, first introduced in 1979, has become one of the most enduring and influential frameworks in modern nursing^1. The theory emphasizes the transpersonal nature of care—where healing occurs not only through clinical intervention but also through authentic presence, spiritual connection, and mutual respect between nurse and patient. Her ten “carative factors,” later revised as “caritas processes,” laid the groundwork for a nursing practice that is both technical and deeply humanistic^2.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;As nursing enters the third decade of the 21st century, this foundational framework faces new challenges. The profession now operates within healthcare systems increasingly shaped by digitalization, automation, structural inefficiencies, and global crises such as the COVID-19 pandemic. These shifts have altered how care is delivered, perceived, and experienced—often disrupting the emotional and relational space required for genuine caring encounters^3,4. Documentation, algorithm-driven decision support, telehealth triage, and electronic medical record use have become central to nursing workflows, often displacing time once devoted to relational presence^5.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Furthermore, the global nature of modern healthcare demands new forms of cultural competence and inclusivity. Nurses are increasingly caring for patients from diverse sociocultural, linguistic, and spiritual backgrounds. While Watson’s theory incorporates sensitivity and faith-hope as carative elements, recent studies have called for deeper integration of cultural humility and anti-oppressive practice into caring science^6.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The pandemic further strained the system, exposing nurses to psychological trauma, compassion fatigue, and burnout at unprecedented levels^7. Ironically, in this environment, the need for caring—for both patients and healthcare workers—has never been more urgent. Yet the traditional definitions and pathways of caring outlined in Watson’s original work may not be sufficient to guide nurses through the complex, high-tech, high-stress realities they now face^8.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Although revisions and expansions of Watson’s theory have emerged—such as “digital caring” frameworks, holistic self-care models, and trauma-informed caring—there remains a gap in empirical, qualitative research that captures how nurses themselves currently interpret and experience caring in practice^9. Especially absent are data that examine the applicability of Watson’s theory in telehealth environments, multicultural contexts, and nursing education platforms that rely on simulation or online learning.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;This study aims to fill that gap by exploring the lived experiences of nurses across different care settings, guided by a phenomenological methodology and Watson’s carative factors as a sensitizing framework. It asks:\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;• How do nurses define and express caring in the current healthcare environment?\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;• In what ways do they feel supported—or constrained—by existing caring theories?\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;• What conceptual expansions or revisions might enhance the relevance of Watson’s framework in 2025 and beyond?\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;By grounding its analysis in the voices of frontline nurses, this study not only offers theoretical refinement but also practical insights for educators, administrators, and policymakers striving to preserve the essence of nursing in a rapidly changing world.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"Background and Literature Review","content":"\u003cp\u003eOverview of Jean Watson’s Theory of Human Caring\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Jean Watson’s Theory of Human Caring, first published in 1979 and later refined into the Caring Science model, is a deeply humanistic and existential theory rooted in the belief that caring is the “essence” of nursing^1. The theory positions the nurse-patient relationship as a sacred, transpersonal connection that facilitates healing on emotional, spiritual, and existential levels.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Originally based on ten carative factors (later reframed as caritas processes), Watson’s theory encourages nurses to integrate intentionality, compassion, creativity, and moral commitment into their clinical practice. These carative elements include:\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;1. The formation of humanistic-altruistic value systems\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;2. The instillation of faith-hope\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;3. The cultivation of sensitivity to oneself and others\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;4. The development of helping-trusting human caring relationships\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;5. The promotion of expression of feelings\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;6. The use of scientific problem-solving\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;7. The promotion of interpersonal teaching-learning\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;8. The provision of a supportive, protective environment\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;9. The assistance with gratification of human needs\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;10. The allowance for existential-phenomenological-spiritual forces^2\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Watson emphasized that caring is not simply a behavior or action but a moral ideal and intentional consciousness directed toward preserving human dignity. This philosophical grounding distinguishes her theory from task-oriented or biomedical nursing models^3.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Contemporary Relevance and Application\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Watson’s theory has been widely applied across specialties such as palliative care, mental health, nursing education, and global health. In palliative settings, for example, her model provides a effective framework for non-judgmental presence, deep listening, and end-of-life dignity^4. In educational environments, the theory fosters caring pedagogy, helping students understand nursing as both science and art^5.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;More recently, Watson’s theory has served as a resilience framework during the COVID-19 pandemic. Nurses and educators turned to her carative factors as emotional anchors, particularly in addressing burnout, ethical stress, and moral injury^6. Projects in the U.S., Brazil, and Iran applied Watson’s principles to strengthen organizational culture and promote holistic self-care among nurses^7,8.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Critiques and Calls for Revision\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Despite its relevance, scholars critique Watson’s theory for lacking specificity in certain clinical contexts, being difficult to operationalize, or not adequately addressing technological and cultural complexities in modern nursing^9. These limitations have prompted suggestions for extensions, revisions, or hybridizations.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Gunawan and colleagues (2022), for example, proposed applying Watson’s theory to nursing administration—arguing for a “caring leadership” model to counteract hierarchical and burnout-prone hospital structures^10. While extending the theory’s domain, this effort revealed that organizational caring requires different concepts than individual nurse-patient interactions.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Digital care delivery is among the most pressing challenges to Watson’s framework. Wynn et al. (2025) discussed how remote care, AI triage tools, and virtual nurse-patient relationships reshape the caring process itself^11. Nurses must now project empathy through screens and interfaces—raising questions about whether the embodied presence central to Watson’s philosophy can be digitally replicated or reconceived.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Likewise, Stewart-Black (2025) questioned whether caring can be taught virtually. In her phenomenological study of nurse educators in online environments, participants expressed that teaching compassion through Zoom and simulation often feels “hollow” and lacks the embodied depth Watson envisioned^12.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Cultural Critiques and Global Adaptations\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Watson’s theory draws heavily on Western philosophical traditions, including existentialism, humanism, and transpersonal psychology. As nursing becomes increasingly global, scholars have challenged the universality of its assumptions.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Chenari et al. (2025) compared Watson’s theory with others—including Katie Eriksson’s Caritative Caring Theory—to assess applicability in Iran. While Watson’s emphasis on dignity and spirituality resonated, cultural expectations about family roles, gender, and authority required more flexible interpretations of “presence” and “caring”^13.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Lacerda et al. (2025) developed a middle-range theory rooted in Watson’s principles but tailored for transpersonal home care in Brazil. Their work emphasized care delivered in patients’ homes—where relationships often extend beyond the clinical encounter and include spiritual, emotional, and familial dimensions not fully articulated in the original theory^14.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;These adaptations suggest that while Watson’s core principles remain powerful, the theory requires more flexible, contextualized frameworks to support culturally safe and socially responsive care.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The Gap This Study Addresses\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;While literature confirms both the enduring power and emerging limitations of Watson’s Theory of Human Caring, there is still a lack of empirical studies examining how nurses themselves experience and interpret “caring” today. Most existing work either applies the theory in specific settings or critiques it philosophically, but few studies ask:\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;• How do nurses operationalize Watson’s carative factors in high-tech or virtual settings?\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;• What barriers do they face in practicing holistic, compassionate care under systemic constraints?\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;• Which aspects of Watson’s theory feel outdated or impractical in 2025?\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;This study addresses that gap using a phenomenological method centered on the lived experiences of nurses in ICU, palliative care, community health, and telehealth. Their narratives reveal both fidelity to Watson’s core values and calls for revision, shaping a more dynamic, future-ready caring science.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"Methodology","content":"\u003cp\u003eResearch Design\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;This study employed a qualitative descriptive phenomenological design, guided by Edmund Husserl’s principles and adapted through Colaizzi’s method of data analysis. The phenomenological approach was chosen to capture the lived experiences of nurses as they interpret and enact caring within today’s complex healthcare environments. Phenomenology aligns philosophically with Watson’s emphasis on transpersonal relationships, intentional presence, and meaning-making in human encounters^1.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Watson’s ten carative factors served as a sensitizing framework to inform the interview guide and early analysis, but they did not restrict the emergence of new codes or themes. This approach preserved the inductive spirit of phenomenology while situating the inquiry in a clear theoretical context.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"Findings","content":"\u003cp\u003eAnalysis of the transcripts revealed six major themes that reflect both affirmation and critical reinterpretation of Jean Watson\u0026rsquo;s Theory of Human Caring. Participants offered nuanced insights into how caring is practiced in modern nursing environments, particularly those mediated by technology, high acuity, or cultural diversity. Their voices underscore the continued relevance of Watson\u0026rsquo;s carative factors but also highlight areas requiring conceptual expansion to remain responsive to the evolving healthcare landscape.\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;Theme 1: Technological Disconnection from the Human Element\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;Participants described tension between task-oriented digital workflows and humanistic caring. Nurses in high-tech environments such as the ICU expressed that automated protocols and electronic documentation often limited opportunities for relational connection.\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u0026ldquo;Some days I feel like I\u0026rsquo;m more of a data technician than a nurse. I care deeply about my patients, but the alarms, the screens, the documentation\u0026mdash;they come first now.\u0026rdquo;\u003cbr\u003e\u0026nbsp;\u0026mdash; Nurse Maya, ICU, 8 years\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;This echoes Gunawan et al. (2022), who argued that administrative and technological demands often marginalize the expressive dimensions of caring^1. Similarly, Wynn et al. (2025) noted that nursing identity is becoming fragmented as clinical judgment is increasingly outsourced to machines^2.\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;Theoretical Implication: Watson\u0026rsquo;s first carative factor\u0026mdash;formation of humanistic-altruistic values\u0026mdash;remains essential, but participants suggested a new carative element addressing digital-human balance and technological compassion fatigue.\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;Theme 2: Digital Empathy and Virtual Caring\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;Nurses working in telehealth described challenges in replicating emotional presence through screens. Though they employed strategies such as tone modulation, pausing, and visual attentiveness, many felt something intrinsic to caring was missing.\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u0026ldquo;I try to make eye contact through the screen, lean in, and nod\u0026mdash;but something is still lost. Caring through a filter just isn\u0026rsquo;t the same.\u0026rdquo;\u003cbr\u003e\u0026nbsp;\u0026mdash; Nurse Janelle, Telehealth, 4 years\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;Watson viewed caring as transpersonal and embodied, requiring more than cognitive empathy^3. However, Wynn et al. (2025) argued that tech-mediated caring is not inherently less authentic but requires a new digital relational literacy^2.\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;Theoretical Implication: Extend Watson\u0026rsquo;s transpersonal caring to explicitly include tech-mediated empathy.\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;Theme 3: Cultural Humility as a Form of Caring\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;Community nurses emphasized caring as a culturally negotiated process rather than a universal action. Being present sometimes meant silence, allowing families to lead, or adjusting assumptions about autonomy or expression.\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u0026ldquo;I had to unlearn my assumptions. I used to think caring meant comforting with words\u0026mdash;but sometimes, silence is what\u0026rsquo;s needed.\u0026rdquo;\u003cbr\u003e\u0026nbsp;\u0026mdash; Nurse Aamir, Community Health, 11 years\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;This aligns with Chenari et al. (2025), who argued that Watson\u0026rsquo;s factors must adapt to cultural contexts^4.\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;Theoretical Implication: Expand Watson\u0026rsquo;s factor on sensitivity to self and others to include cultural humility and anti-oppressive care.\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;Theme 4: Presence Over Procedure\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;Palliative care nurses provided the strongest affirmations of Watson\u0026rsquo;s emphasis on presence. Their stories reflected moments of deep connection transcending interventions.\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u0026ldquo;One patient told me the most healing thing I did wasn\u0026rsquo;t managing her pain meds\u0026mdash;it was sitting quietly and holding her hand. Just being there.\u0026rdquo;\u003cbr\u003e\u0026nbsp;\u0026mdash; Nurse Carla, Palliative Care, 14 years\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;This resonates with Aghaei et al. (2020), who applied Watson\u0026rsquo;s theory in palliative care and found that presence was more therapeutic than procedures^5.\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;Theoretical Implication: Reaffirm Watson\u0026rsquo;s framework, particularly factors emphasizing authentic presence and existential connection, while advocating system-level restructuring to enable such encounters.\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;Theme 5: Caring Pedagogy in Virtual Education\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;Educators in the study expressed concern about teaching caring in online platforms. While clinical content translated well, modeling compassion and ethical comportment was perceived as deficient.\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u0026ldquo;I can teach theory on Zoom. But I can\u0026rsquo;t teach presence. I can\u0026rsquo;t role-model empathy through a screen.\u0026rdquo;\u003cbr\u003e\u0026nbsp;\u0026mdash; Nurse Sophia, Educator, 6 years\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;This reflects Stewart-Black (2025), who found that virtual nursing education often lacks embodied, relational depth^6. Labrague and Obeidat (2025) similarly argued that online training risks reducing caring to skills rather than a way of being^7.\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;Theoretical Implication: Introduce a new carative factor focused on \u0026ldquo;Caring Pedagogy in Digital Learning Environments.\u0026rdquo;\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;Theme 6: Emotional Fatigue and the Need for Self-Compassion\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;Emotional exhaustion was pervasive. Nurses described a gradual erosion of empathy, linked to burnout, moral distress, and lack of systemic support.\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u0026ldquo;I used to cry with my patients. Now I feel like a stone. It\u0026rsquo;s not that I don\u0026rsquo;t care\u0026hellip; I just can\u0026rsquo;t absorb any more.\u0026rdquo;\u003cbr\u003e\u0026nbsp;\u0026mdash; Nurse Daniel, Emergency Nurse, 12 years\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;Watson\u0026rsquo;s framework assumes an emotionally available caregiver, yet crises revealed that nurses often suppress emotion to survive. Watson herself addressed this during COVID-19, emphasizing resilience and holistic self-care strategies^8.\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;Theoretical Implication: Add a carative factor centered on \u0026ldquo;Caring for the Caregiver\u0026rdquo;\u0026mdash;highlighting self-compassion, boundaries, and emotional sustainability.\u003c/p\u003e\n\u003cp\u003eBased on participants\u0026rsquo; experiences and in alignment with current literature, Table 2 presents a comparative summary of Watson\u0026rsquo;s original carative factors and the proposed revisions required to address contemporary nursing challenges.\u003c/p\u003e\n\u003cp\u003eSynthesis of Themes\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;A synthesis of emergent themes, related literature, and proposed theoretical revisions is shown below.\u003cbr\u003e\u0026nbsp;\u003cbr\u003e \u003cstrong\u003eTable 1. Summary of Emergent Themes, Supporting Literature, and Proposed Carative Additions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eDerived from participant interviews and corroborating literature\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"3\" cellpadding=\"0\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eTheme\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eSupported By\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eProposed Carative Addition\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eTech Disconnection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eGunawan et al. (2022), Wynn et al. (2025)\u0026sup1;\u0026sup2;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eDigital-Human Balance\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eDigital Empathy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eWynn et al. (2025), Watson (2008)\u0026sup2;\u0026sup3;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eTech-Mediated Empathy\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eCultural Humility\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eChenari et al. (2025)⁴\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eCulturally Safe and Humble Practice\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ePresence Over Procedure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eAghaei et al. (2020)⁵\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(Reaffirm) Authentic Presence\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eCaring Pedagogy (Virtual)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eStewart-Black (2025), Labrague \u0026amp; Obeidat (2025)⁶⁷\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eDigital Caring Pedagogy\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eEmotional Fatigue\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eWatson et al. (2021)⁸\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eSelf-Compassion for the Caregiver\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe findings provide both affirmation and critique of Watson’s Theory of Human Caring. Participants recognized the continued relevance of carative factors—particularly presence, intentionality, and transpersonal relationships—but called for revisions to address realities such as digital care, emotional fatigue, and cultural diversity.\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;This discussion is structured around three domains: (1) Implications for theory, (2) Implications for practice and education, and (3) Directions for future research.\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;Theoretical Implications: Preserving Core Values, Expanding Contexts\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;Watson’s theory, developed in a pre-digital, primarily Western environment, assumes caring is demonstrated interpersonally³. Yet, this study shows caring now occurs across non-physical interfaces such as telehealth consultations and online education platforms—challenging traditional ideas of presence and embodiment.\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;Participants affirmed core carative factors but urged translation into digital contexts. Wynn et al. (2025) have begun this work through tech-mediated empathy models². Similarly, Chenari et al. (2025) advocated for pluralistic frameworks that are culturally responsive⁴. Nurses here proposed replacing universalistic assumptions with cultural humility, defined as reflexive acknowledgment of power imbalances and diverse patient worldviews.\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;Another theme was the psychological toll of caregiving. Though Watson emphasized spiritual self-development, she did not explicitly address emotional depletion. Participants advocated adding a factor focused on “caring for the caregiver,” echoing Watson’s recent writings on resilience during COVID-19⁸.\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;Together, these findings suggest Watson’s theory must evolve from a static philosophical model into a dynamic, adaptive framework capable of guiding nurses through technological, cultural, and emotional complexity.\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;Implications for Practice and Education\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;Clinical practice. Caring cannot be reduced to competence or task performance. Technology enhances efficiency but can erode relational essence if not balanced with intentional presence. ICU and telehealth nurses described emotional erosion due to constant screen interaction, echoing Gunawan et al. (2022)^1. Health systems must protect space for presence by redesigning staffing models, embedding reflective spaces, and incorporating caring science into leadership.\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;Education. Findings underscore urgent pedagogical challenges. Educators struggled to model caring in digital classrooms. As Labrague and Obeidat (2025) noted, content delivery cannot instill caring values⁷. Watson also argued caring is not merely something nurses do but a way they are³.\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;Simulation, storytelling, and role-modeling empathy—even online—may partially address this gap. Yet, embodied mentorship remains irreplaceable (Stewart-Black, 2025)^6. Curricula must ensure hybrid formats that include relational modeling, not just knowledge transfer.\u003cbr\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 2. Comparison of Original vs. Revised Carative Factors\u003cbr\u003e\u0026nbsp;\u003cem\u003eAdapted from participants' narratives and supporting literature\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"3\" cellpadding=\"0\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eOriginal Carative Factor\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eProposed Revision / Expansion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eHumanistic-altruistic values\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eInclude digital compassion fatigue and tech overload¹\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eTranspersonal caring relationship\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eAdd tech-mediated empathy²\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eSensitivity to self and others\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eExpand to include cultural humility⁴\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eSpiritual growth and caring consciousness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eIntegrate self-compassion and emotional sustainability⁸\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eTeaching-learning\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eUpdate for virtual learning environments⁶,⁷\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;Directions for Future Research\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Future studies should examine:\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;• How digital interfaces (telehealth, AI) affect nurses’ capacity to form transpersonal connections.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;• Integration of caring science into leadership and systems-level strategies.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;• Long-term effects of tech-mediated caring on nurse retention and patient outcomes.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;• Development of intercultural caring frameworks co-designed with patients.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Quantitative studies could also test whether revised carative factors reduce burnout or improve satisfaction—linking caring science with measurable outcomes.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Conclusion of Discussion\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;This study affirms that Watson’s Theory of Human Caring remains a moral and philosophical anchor but requires adaptation to reflect the technological, emotional, and cultural terrain of modern practice. The voices of nurses in this study provide not only critique but also a vision for a renewed, contextually grounded theory.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Conclusion and Implications\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;This study explored how nurses interpret, experience, and operationalize caring in light of Jean Watson’s Theory of Human Caring. Through phenomenological analysis of interviews across ICU, telehealth, community, and palliative care, findings revealed affirmations of Watson’s principles alongside calls for revision.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Participants valued Watson’s emphasis on authentic presence, faith-hope, and transpersonal connection³, but described barriers including digital fragmentation, cultural misalignment, burnout, and diminished caring pedagogy online. These mirror concerns in current literature about the disconnect between ideals and realities¹,²,⁷.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Proposed revisions include:\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;• Digital-Human Balance – addressing emotional strain in technology-saturated environments¹\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;• Tech-Mediated Empathy – acknowledging intentional care through digital means²\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;• Cultural Humility – moving beyond sensitivity toward reflexive, power-aware practice⁴\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;• Self-Compassion and Emotional Sustainability – ensuring care is viable for nurses, not just patients⁸\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;• Caring Pedagogy in Digital Education – preserving value transmission in online formats⁶,⁷\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;These additions strengthen, rather than dilute, Watson’s vision—ensuring relevance in a world where caring often navigates distance, complexity, and uncertainty.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Implications for Practice:\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Healthcare leaders must ensure organizational structures that support caring, not just productivity. This includes reducing documentation burdens, supporting wellness with trauma-informed cultures, and embedding caring science into leadership and performance frameworks¹,⁸.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Implications for Education:\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Nursing education must foster ontological development of the nurse as a caring professional. Hybrid learning with in-person mentorship, empathy-focused simulation, and faculty training in digital caring pedagogy are essential⁶,⁷.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Implications for Theory and Research:\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Future research should test proposed additions across diverse settings, develop metrics for digital caring and presence, and co-create frameworks with marginalized groups to ensure inclusivity⁴.\u003c/p\u003e"},{"header":"Final Reflection","content":"\u003cp\u003eJean Watson’s Theory of Human Caring has guided generations through its visionary emphasis on healing presence and sacred relationships. Like all enduring theories, it must evolve. This study affirms caring as the heartbeat of nursing, now required to flow through machines, across cultures, and within the hearts of exhausted healers.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;A revised, resilient, and inclusive Caring Science 2.0 will guide nurses in 2025 and beyond, restoring meaning, dignity, and wholeness to a profession the world entrusts with its most vulnerable moments.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical Approval and Consent to Participate\u003c/strong\u003e\u003cp\u003eThis study was approved by the Philippines Research Ethics Committee (Approval #2025-A-826A). All participants received detailed information and provided written informed consent. Standards were upheld in accordance with the Declaration of Helsinki and institutional guidelines.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConsent for Publication\u003c/strong\u003e\u003cp\u003eParticipants consented to anonymous publication of direct quotes. Identifying details were removed.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eAvailability of Data and Materials\u003c/h2\u003e\u003cp\u003eDatasets are not publicly available due to confidentiality agreements but may be requested from the corresponding author.\u003c/p\u003e\u003cp\u003eCompeting Interests\u003c/p\u003e\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\u003cp\u003eFunding\u003c/p\u003e\u003cp\u003eThis research received no specific grant from funding agencies.\u003c/p\u003e\u003cp\u003eAuthors\u0026rsquo; Contributions\u003c/p\u003e\u003cp\u003eDr. Fernan Torreno conceived the study, collected and analyzed data, and drafted the manuscript. Famiela Torreno contributed to interpretation, revisions, and language editing. All authors approved the final version.\u003c/p\u003e\u003cp\u003eAcknowledgments\u003c/p\u003e\u003cp\u003eThe authors thank the nurses who generously shared their time and experiences.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003e Gunawan J, Aungsuroch Y, Watson J. Nursing administration and Watson\u0026rsquo;s theory of human caring: A contemporary application. Nurs Sci Q. 2022;35(2):150\u0026ndash;156. doi:10.1177/08943184221079124\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e Wynn M, Da Silva THR, Pearson-Jenkins J. Digital nursing and nursing theory: New directions in caring science. Taylor \u0026amp; Francis; 2025.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e Watson J. Nursing: The philosophy and science of caring. Rev. ed. University Press of Colorado; 2008.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e Chenari HA, Forouzanfar H. Comparing four caring theories for application in Iranian nursing contexts: A critical review. Nurs Sci Q. 2025;38(1):34\u0026ndash;40. doi:10.1177/0894318424123456\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e Aghaei MH, Vanaki Z, Mohammadi E. Application of Watson\u0026rsquo;s theory of human caring in palliative care: A qualitative study. Int J Community Based Nurs Midwifery. 2020;8(2):145\u0026ndash;154. doi:10.30476/IJCBNM.2020.81633.0\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e Stewart-Black WR. Nurse educators\u0026rsquo; experiences of modeling and teaching caring in online learning environments [dissertation]. ProQuest Dissertations Publishing; 2025.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e Labrague LJ, Obeidat AA. Pedagogical approaches to foster caring behaviors among nursing students in virtual learning environments. Nurse Educ Today. 2025;130:105696. doi:10.1016/j.nedt.2025.105696\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e Watson J, Moreno JV, Borgueta E. COVID-19: An organizational-theory-guided holistic self-caring and resilience project for frontline nurses. J Holist Nurs. 2021;39(4):324\u0026ndash;333. doi:10.1177/08980101211022153\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e Meneses-La-Riva ME, Fern\u0026aacute;ndez-Bedoya VH. Humanized care in nursing practice: A phenomenological study. Int J Environ Res Public Health. 2025;22(8):1223. https://www.mdpi.com/1660-4601/22/8/1223\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Jean Watson, Human Caring, Carative Factors, Nursing Theory, Phenomenology, Digital Health, Caring Pedagogy, Cultural Humility, Nurse Burnout","lastPublishedDoi":"10.21203/rs.3.rs-7730600/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7730600/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eJean Watson’s Theory of Human Caring has long served as a foundational framework in nursing, emphasizing transpersonal relationships, intentional presence, and holistic care. Today’s healthcare landscape—marked by digital technologies, cultural pluralism, and systemic burnout—introduces complexities that challenge the operationalization of Watson’s original carative factors¹,².\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAim:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study explores how nurses practicing in contemporary clinical and digital contexts experience and interpret caring, and whether their lived realities align with or diverge from Watson’s theoretical constructs.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA descriptive phenomenological design was adopted, utilizing Colaizzi’s seven-step method for data analysis. Semi-structured interviews were conducted with 15 registered nurses across intensive care, telehealth, palliative, and community health settings. Watson’s ten carative factors served as a sensitizing framework, while leaving space for inductively derived themes to emerge.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSix major themes were identified: (1) Technological Disconnection from the Human Element, (2) Digital Empathy and Virtual Caring, (3) Cultural Humility as a Form of Caring, (4) Presence Over Procedure, (5) Caring Pedagogy in Virtual Education, and (6) Emotional Fatigue and Self-Compassion. While Watson’s theory was largely affirmed in principle, participants emphasized gaps between theory and practice, particularly in digitally mediated care³, culturally safe encounters⁴, and self-sustaining emotional labor⁵. Nurses proposed revisions to the theory, including new carative dimensions such as tech-mediated empathy, caregiver self-compassion, and culturally responsive presence.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWatson’s Theory of Human Caring remains philosophically robust but requires theoretical expansion to maintain practical relevance in 21st-century nursing. A revised framework—integrating digital, emotional, and intercultural dimensions—can sustain the core humanistic values of caring while aligning with the realities of modern practice.\u003c/p\u003e","manuscriptTitle":"Reimagining Human Caring in Contemporary Nursing Practice: A Phenomenological Study Guided by Jean Watson’s Theory","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-30 09:43:47","doi":"10.21203/rs.3.rs-7730600/v1","editorialEvents":[{"type":"communityComments","content":2}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"16a6c00f-51ba-4479-8b38-98df2c4a4b46","owner":[],"postedDate":"September 30th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":55566888,"name":"Nursing"},{"id":55566889,"name":"Psychology"}],"tags":[],"updatedAt":"2025-09-30T09:43:47+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-30 09:43:47","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7730600","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7730600","identity":"rs-7730600","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}