(For the content and description of the original carative factors, see Watson, 1979/1985, 1985/1988c, 1989; also see Fawcett, 1993 for a brief overview of the carative factors).

While some of the basic tenets of the original carative factors still hold, and indeed are used as the basis for some theory-guided practice models and research, what I am proposing here, as part of my evolution and evolution of these ideas and the theory itself, is to transpose the "carative factors" into "clinical caritas processes". For example, consider the following within the context of clinical caritas, and emerging, transpersonal caring theory.

The original carative factors served as a guide to what was referred to as the "core of nursing";, in contrast to nursing's "trim". Core pointed to those aspects of nursing that potentiate therapeutic healing processes and relationships; they affect the one caring and the one-being-cared-for. Further, the basic core was grounded in what I referred to as the philosophy, science, and art of caring. Carative is that deeper and larger dimension of nursing that goes beyond the "trim" of changing times, setting, procedures, functional tasks, specialized focus around disease, treatment and technology. While the "trim" is important and not expendable, the point is that nursing cannot be defined around its trim and what it "does" in a given setting at a given point in time. Nor can nursing's trim define and clarify its larger professional ethic and mission to society - its raison d'etre for the public. That is where nursing theory comes into play and transpersonal caring theory offers another way, that both differs from, yet complements, that which has come to be known as "modern" nursing and conventional medical-nursing frameworks.

From Carative Factors To Clinical Caritas Processes

As carative factors evolve within an expanding perspective, as my ideas and values evolve, I now offer the following translation of the original carative factors into clinical caritas processes, suggesting more open ways in which they can be considered. For example,

What differs in the Clinical Caritas framework is that a decidedly spiritual dimension and an overt evocation of love and caring merge into a new paradigm for the next millennium. Such a perspective ironically places nursing within its most mature framework, consistent with the Nightingale model of nursing, yet to be actualized, but awaiting its evolution within a caring-healing theory. This direction, ironically while embedded in theory, goes beyond theory and becomes a converging paradigm for nursing's future.

Thus, I consider my work more a philosophical, ethical, intellectual blueprint for nursing's evolving disciplinary/professional matrix, rather than a specific theory per sé. Nevertheless, others interact with the original work at levels of concreteness or abstractness; the caring theory has been, and is being used, as a guide for educational curricula, clinical practice models, methods for research and inquiry, as well as administrative directions for nursing and health care delivery.

This work posits a value's explicit moral foundation and takes a specific position with respect to the centrality of human caring, "caritas" and love as now an ethic and ontology, as well as a critical starting point for nursing's existence, broad societal mission, and the basis for further advancement for caring-healing practices. Nevertheless, it's use and evolution are dependent upon "critical, reflective practices that must be continuously questioned and critiqued in order to remain dynamic, flexible, and endlessly self-revising and emergent" (Watson, Blueprint; 1996, p. 143).

Ironically, this work is congruent with recent reports on health care and health professional educational reform, which call for "centrality of caring-healing relationships" as the foundation for all health professional education and practice reform. I quote:

The central task of health professions education - in nursing, medicine, dentistry, public health, psychology, social work, and the allied health professions - must be to help students, faculty, and practitioners learn how to form caring, healing relationships with patients, and their communities, and with each other, and with themselves…the knowledge, skills, and values necessary for effective relationships… Developing practitioners mature as reflective learners and professionals who understand the patient as a person, recognize and deal with multiple contributions to health and illness, and understand the essential nature of healing relationships.

Clinical Caritas and Caritas Processes

"Caritas" comes from the Latin word meaning to cherish, to appreciate, to give special attention, if not loving, attention to; it connotes something that is very fine, that indeed is precious. Katie Eriksson in Finland has used the word caritas in her theory of caring to convey similar meanings.

The word "caritas" also is closely related to the original word "carative" from my 1979 book. At this time I now make new connections between carative, caritas and without hesitation invoke the "L" word, which caritas conveys, that is love, allowing love and caring coming together for a new form of deep transpersonal caring.  This relationship between love and caring connotes inner healing for self and others, extending to nature, and the larger universe, unfolding and evolving within a cosmology that is both metaphysical and transcendent with the co-evolving human in the universe (Watson, 1998).

"Clinical Caritas" is an emerging model of transpersonal caring and moves from carative to caritas. This integrative expanded perspective is both postmodern, in that it transcends conventional industrial, static models of nursing, while simultaneously evoking both the past and the future. For example, the future of nursing is ironically tied back to Nightingale's sense of "calling", guided by a deep sense of commitment and a covenantal ethic of human service; cherishing our phenomena, our subject matter, and those we serve. It is when we include caring and love in our work and our life that we discover and affirm that nursing, like teaching, is more than just a job, but a life-giving and life-receiving career for a lifetime of growth and learning. Such maturity and integration of past with present and future, now require transforming self, and those we serve, including our institutions, and the profession itself. As we more publicly and professionally assert these positions for our theories, our ethics and our practices, even our science, we also locate ourselves and our profession and discipline within a new, emerging cosmology. Such thinking calls for a sense of reverence and sacredness with regard to life and all living things. It incorporates both art and science, as they are also being redefined, acknowledging a convergence between art, science, and spirituality. As one enters into the transpersonal caring theory and philosophy, one simultaneously is challenged to relocate themselves in these emerging ideas and question for themselves how the theory speaks to them, inviting them into a new relationship with themselves and their ideas about life, nursing, and theory. In this framework each one is also asked, if not enticed to examine and explore the critical intersection between the personal and the professional; to translate their unique talents, interests, and gifts into human service of caring and healing, for self and others, and even the planet Earth itself.