Caring in Motion: The Intersection of the Science of Caring and Safe Patient Handling Practices
Lori A. Severson, CSP National Director of Risk Control Solutions -Healthcare Lockton

INTRODUCTION

Professionals have studied moving patients for decades. So much so, healthcare it is a “known occupational hazard” by Federal & State OSHA programs. Healthcare Workers (HCWs) have career ending injuries moving a patient in a care setting. These mobility tasks are a moment of profound vulnerability & liability for all involved. The “movement” of bodies is often a manual exertion task of lifting, pushing, pulling and the burden of these repetitive actions is costly . As these severe incidents continue to happen we as safety professionals have to question why and open our minds to the fact we may be missing something in our approach. Could Safe Patient Handling be enhanced through an existing philosophical and theoretical framework called Caritas? Caritas is a holistic theory-guided practice of human caring and love! It is a human element that has been influential in major health systems in the US and globally through the promotion of patient-centered care, nursing excellence and professional leadership. This paper posits SPHM may be refreshed, revitalized and possibly enhanced through a focus on leadership & peer support skills called Watson Caring Science. Here’s how.

What It Is

Watson Caring Science (WCS) is a philosophical and ethical framework developed by Dr. Jean Watson, originating with her 1979 book Nursing: The Philosophy and Science of Caring. At its core, it reframes nursing as a deeply human practice — one that treats the patient as a whole person (mind, body, and spirit) rather than simply a diagnosis or condition to be treated.

The framework is built around 10 Caritas Processes® — guiding principles that emphasize compassion, authentic presence, empathy, active listening, and a meaningful therapeutic relationship between nurse and patient. It holds that caring is complementary to curing — both are essential to quality healthcare.

Key tenets include:

• Holistic care — addressing biological, emotional, psychosocial, and spiritual needs together
• Transpersonal caring relationships — genuine, human-to-human connection between clinician and patient
• Caring environment — providing comfort, privacy, dignity, and safety as core nursing responsibilities
• Ethical and humanistic responsibility — blending scientific knowledge with moral accountability

 How It Improves Patient Safety

While WCS is often associated with compassion and culture, it has direct and measurable patient safety implications:

1. Stronger nurse-patient communication — Active listening and authentic presence help nurses detect subtle changes in patient condition earlier, reducing missed deterioration events.
2. Reduced errors through mindful practice — A caring-centered mindset encourages intentionality and attentiveness, which counters the rushed, task-focused behaviors that contribute to medication errors and procedural mistakes.
3. Improved patient engagement — When patients feel genuinely heard and respected, they are more likely to report symptoms, ask questions, and adhere to care plans — all of which reduce adverse events.
4. Safer care environments — WCS explicitly calls for nurses to provide supportive, protective, and corrective physical and mental environments, embedding safety directly into the caring model.
5. Reduced nurse burnout — Organizations that adopt WCS principles tend to see improved nurse satisfaction and retention. Burned-out, understaffed units are a well-documented patient safety risk; a caring culture helps mitigate this.
6. Reduction of stigma and bias — Research shows WCS-informed care reduces discriminatory treatment of vulnerable populations (e.g., patients with substance use disorders), ensuring equitable and safer care for all patients.

The intersection of Dr. Jean Watson’s Science of Caring and the American Nurses Association’s (ANA) Safe Patient Handling and Mobility (SPHM) are two theories with the same imperative: “do no harm”. Woven together the fabric of care is stronger & explains the why to this moral & physical safety net.

THE SCIENCE OF CARING: A FRAMEWORK FOR HUMAN DIGNITY

Dr. Jean Watson’s Theory of Human Caring reframes nursing as a transpersonal, relational practice grounded in compassion, presence, and holistic healing. Her 10 Caritas Processes from “practicing loving-kindness” to “creating a healing environment” are not abstract ideals. They are actionable commitments that shape every clinical encounter and could be part of a comprehensive SPHM program.

Central to Watson’s framework is the recognition that the nurse-patient relationship is sacred. The nurse is not a technician performing tasks; nurses and all medical professionals offer a healing presence. They honor the whole person mind, body, and spirit. This theory puts words to what nurses have always done. That nurses protect not only the patient’s clinical outcomes but also their dignity, comfort, and sense of safety.

What is less often discussed, but equally vital, is that Watson’s ethic of caring extends to the nurse herself. We need to more strongly establish the expectation from day one of nursing and medical professional training that as carers it starts with self. We will never have safety if we never establish this as required learning criteria. A nurse who is injured whose back is strained from a manual lift & transfer, whose body is worn from repeated overexertion cannot be fully present to provide care that won’t cause harm. Healthcare workers cannot embody the Caritas processes if we don’t agree their safety is step #1. The Science of Caring, therefore, is incomplete without a commitment to the safety of the caregiver. This small but commonly overlooked step of establishing HCW safety as the requirement of quality care is the missing link. Caritas programs can help fill this void.

THE BURDEN OF MANUAL HANDLING: A US HEALTHCARE CRISIS OF CARING

The data are unambiguous. According to the ANA’s SPHM Guidelines, healthcare workers suffer musculoskeletal disorders (MSDs) at rates higher than construction, mining, or manufacturing workers. In 2011, nursing assistants reported 25,010 MSD cases resulting in lost work time, the highest of any occupation. Registered nurses ranked fifth, with 11,880 cases. Eighty percent of nurses reported working through frequent musculoskeletal pain.

These are not just safety statistics. These are humans who are caring, committed professionals. They didn’t go to school to become injured. But the HCW’s bodies for too long are being sacrificed in the act of caring for others. This is a fact that doesn’t make front page news, and few patients realize what these mobility tasks do to their carers. This is a moral failure that Watson’s framework sets out to confront. When a nurse is injured lifting a patient manually, the Caritas processes are broken: the healing environment is compromised, the therapeutic relationship is disrupted, and the patient’s safety is at risk.

MECHANICAL LIFTS AND SLINGS: CARITAS IN ACTION

The ANA’s SPHM Guidelines call for a paradigm shift: the elimination of manual patient handling in favor of evidence-based technology, mechanical lifts, ceiling-mounted systems, friction-reducing devices, multipurpose slings, and lateral transfer aids. This is not a retreat from caring for the HCW. It is caring, made scalable & sustainable.

Consider Watson’s Caritas Process of “creating a healing environment at all levels.” A mechanical lift, properly used, transforms a potentially traumatic transfer into a smooth, dignified experience. The patient is supported, not dragged. The nurse is present, their hands free to touch and reassure, eyes free to connect, a voice free to comfort & a face free to smile versus grimace. The technology does not replace the human relationship; it protects it for both patient and HCW.

Consider, too, the Caritas commitment to “being authentically present.” A nurse who fears injury during a transfer who braces herself, rushes the process, or avoids repositioning a patient because her back already aches cannot be authentically present. SPHM technology removes that fear, restoring the nurse’s capacity for full, attentive, compassionate care.

The ANA’s SPHM Guideline calls for patient-centered SPHM assessments integrated into the electronic health record / plan of care. This mirrors Watson’s insistence on individualized, whole-person care. A sling is selected not just for weight capacity or girth, but most importantly for the patient’s comfort, for the dual dignity of workers and patients, and being able to realistically achieve mobility goals. The SPHM mobility assessment is not just a task, with Caritas training carers learn it is a caring act for themselves and those they care for.

OUTCOMES: WHERE CARING AND SAFETY CONVERGE

When a Certified SPHM Clinician/Leader develops a comprehensive program are the outcomes (lower injury rates, reduced patient falls and skin tears) are all standard. What if we collectively begin to measure via evidence based surveys the quality of care? Could staff retention improve? Could patient satisfaction rise via an enhanced SPHM program model that has added Certified Caritas Coaches & processes? Because, we aren’t successful yet. I posit the safety of HCWs requires first, we teach Dr. Jean Watson’s science of caring within the SPHM program & training. We can’t have healing environments if we don’t first prioritize in science based process of Watson’s vision that it begins with self. Safety for all will then become real and measurable beyond the lagging indicators of injury rates.

The Joint Commission and the Lucian Leape Institute have both affirmed that safer environments of care directly improve the quality of patient care. Safety and caring are not competing values. They are the same value, expressed in different languages.

A CALL TO ACTION – Expand your SPHM program to include Certified Caritas Coaches & Processes

Watson’s Science of Caring asks nurses to practice loving-kindness first toward themselves, then to their patients, and their colleagues & organization. Choosing a mechanical lift over a manual transfer is an act of loving-kindness. It says: I I value my own body & safety first, then and only then can I value a patient’s safety, dignity & care for embodied healing. I value my ability to keep caring tomorrow. Let’s stop breaking HCWs. The science of caring is the missing link.

The ASPHP stands at the intersection of these two great commitments. Safe patient handling is not a “confirmation of skills” nor strictly a compliance exercise. It is a moral practice, a living expression of the Caritas processes. With Caritas processes enacted every transfer a nurse reaches first for a sling instead of 4 colleagues and demands that straining their backs is NOT “part of doing business”… every time. We must collectively stand in the science of caring and demand a ceiling lift glides a patient (when needed) is safely moved from bed to chair, every time. Only then will our healthcare workers go home whole each day.

Caring is not diminished by technology. It is protected by it.

To learn more about Certified Caritas Processes & The Watson Caritas Measures® click here.

REFERENCES

• Watson, J. (2008). Nursing: The Philosophy and Science of Caring (Rev. ed.). University Press of Colorado.
• American Nurses Association. (2013). Safe Patient Handling and Mobility: Interprofessional National Standards Across the Care Continuum.org.
• Bureau of Labor Statistics, U.S. Department of Labor. (2012). Nonfatal Occupational Injuries and Illnesses by Private Industry Sector, 2011.
• The Joint Commission. (2012). Improving Patient and Worker Safety: Opportunities for Synergy, Collaboration and Innovation.
• National Patient Safety Foundation / Lucian Leape Institute. (2013). Through the Eyes of the Workforce: Creating Joy, Meaning, and Safer Health Care.
• Watson Caring Science Institute. Watson Caritas Patient Score® – Watson Caring Science Institute
  watsoncaringscience.org