Case Report

A Case Report Based on Watson’s Theory of Human Caring Model: Child with Corrosive Esophageal Injury and the Child’s Parents


  • Nazife Gamze Özer Özlü
  • Fatma Vural
  • Kübra Yasak

Received Date: 16.05.2021 Accepted Date: 14.07.2021 J Pediatr Res 2022;9(1):92-96

Corrosive esophageal injuries are mostly traumatic in childhood. In this case report, the child suffering from nutritional problems due to corrosive esophageal injury and her parents are discussed according to Watson’s Theory of Human Caring Model. It is also intended to set an example for using a model in nursing care in the field of pediatric surgery. Since love and compassion are at the center of this model, it was applied comfortably in the department of pediatric surgery. Because in the department of pediatric surgery, love, compassion, and understanding are shown as well as supporting the child and parents to be operated on. In the case, nursing care was applied over the three basic concepts of the model. The child, mother and father were supported and observed with the caritas processes that started in the preoperative period and continued after the surgery. As a result of the care given and the authentic relationship established according to this model, the satisfaction of the child and her parents increased.

Keywords: Child, corrosive esophageal injury, family, nursing care, Watson’s Theory of Human Caring Model


Corrosive esophageal injuries are a major health problem worldwide, especially in middle-income countries. The main purpose in the treatment of these injuries is the survival of the child, the prevention of perforation and esophageal stenosis, the preservation of oral nutrition and the continuity of quality of life (1,2). Therefore, nurses should get to the core of children’s needs by using nursing models in the care of children with these injuries. They should also establish an authentic and understandable relationship with the patient’s parents (3).

Watson’s Theory of Human Caring Model, which is one of the nursing models that help nurses to provide this care, defines the basis of nursing care as science and art (3-5). Since love and compassion are at the center of this model, it requires knowing the strengths and weaknesses of individuals and their reactions to events (5-10). In order to achieve all this, this model with three basic concepts is needed, namely, a transpersonal caring relationship, a caring moment, and caritas processes.

In this case, the problems and care of a 6-year-old girl and her parents who were hospitalized for gastric transposition surgery due to corrosive esophageal injury were evaluated according to Watson’s Theory of Human Care Model.

Case Report

This case report was made in accordance with the CARE Guidelines Checklist.

Case Information and Clinical Findings

The patient was a girl and she had accidentally drunk drain-cleaner at the age of five. Immediately after the accident, the girl’s parents took her to a hospital. She was treated for 45 days in the hospital. Due to respiratory distress, the patient was connected to a mechanical ventilator. In the following days, when she could not be taken off the mechanical ventilator, a tracheostomy was performed. She could not be fed orally because of the stenosis in the long segment of the esophagus. Therefore, enteral feeding started from the gastrostomy. She was dilated nine times in the hospital, but these dilatations failed. Thereupon, her parents applied to the pediatric surgery of a university hospital in another city.

At the age of six, the patient underwent gastric transposition surgery. She was in the intensive care unit for six days after the operation and was monitored for three days with a mechanical ventilator. After being taken off the mechanical ventilator, she suffered from coughing and secretion. An attempt was made to initiate enteral feeding via a jejunostomy followed by oral intake in intensive care. When the child’s general condition stabilized, she was brought to the service and was kept under surveillance for 14 days.


This model was started from the moment the child first came to the clinic and continued until her discharge from hospital (Figure 1).

Diagnostic Assessment

In the perioperative process, chest radiography, laboratory tests (hemogram, biochemistry, coagulation) and blood product preparation were performed.

Therapeutic Intervention

Nursing care was applied to the child and parents via the three basic concepts of this model: transpersonal care relationship, caring moment, and caritas processes.

Transpersonal Caring Relationship

The transpersonal caring relationship is the first basis for going to deep care known as the caring moment, with love and respect for all humanity (4). Looking at the family’s past perceptions, her parents stated that the child was in a peaceful and happy family. It was seen that the child and her parents were tired and exhausted. The parents stated that the girl was nervous and had psychological problems due to the recurrent surgeries. The mother was tired of coming to the hospital all the time and the father was anxious. The parents were asked, “Can you inform us about your goals and expectations after leaving here?” for interaction. As a part of the transpersonal caring relationship, before the gastric transposition surgery, the parents and the child were supported via the efforts of the nurse, physician, and dietitian.

Caring Moment

The caring moment is the moment when two people with their own history come together and create a meaningful, authentic, and spiritual connection between them (4). The first maintenance moment started a bit unfavorably as the child was contacted in order to apply an intravenous catheter. In the later moments of care, arrangements were made regarding nutrition, which is the most basic requirement in the perioperative period.

Caritas Processes

The caritas process is the essence of nursing and is a guide for nurses. These processes lead to the emergence of the healing and caring aspect of nursing. The caritas processes consist of 10 caritas factors (4). In this context, the evaluation of the child and her parents is given in Table I.

Patient Follow-up and Outcomes

In this case, there was a high level of anxiety in the child and the parents, as well as a sense of helplessness and guilt in the parents. The girl and her parents were supported by the perioperative caritas processes. The girl and her parents were observed in line with the nursing interventions. The result of this observation was evaluated both objectively (weight monitoring, respiratory sounds, and self-care requirements) and subjectively (parents’ feedback). The parents and the child’s self-confidence increased, they became happier and calmer individuals. While communicating with the nurse, they were more comfortable and were able to go into deeper issues. Before being discharged, the child wanted to be photographed with the nurse.


This section is discussed over the three basic concepts of this model. These are the interpersonal caring relationship, the caring moment and the caritas processes.

This model has been used in the care of chronic diseases such as hypertension, chronic heart failure, and cancer which require long-term treatment in nursing (6-10). In this case report, this model was used for a child who had come 22 times into the pediatric surgery unit.

Transpersonal Caring Relationship

The transpersonal caring relationship involves the scientific, professional, ethical, aesthetic, creative and personalized giving and taking behaviors and reactions between nurses and patients. In this model, a holistic approach is used in the interpersonal care relationship (5). Based on this model, Aktaş et al. (8) were able to express the hidden feelings and thoughts with the interaction established in a case diagnosed with schizophrenia (9). In a study conducted on this subject in a pediatric intensive care unit, it was found that a unique relationship with pediatric patients was able to be established using this model (10). In this case, the nurse tried to establish a natural, sincere and authentic relationship with the child and the parents. The nurse asked the child and their parents to express themselves, share their experiences and express their expectations in order to evaluate this area. Thus, an attempt was made to establish a relationship of trust between the nurse, patient and parents.

Caring Moment

The caring moment in this model is the process of understanding each other between the caregiver and the care-recipient (4). Erbay et al. (7) highlighted a sincere, understanding and patient approach to those patients who experience hypertensive attacks by using this model in nursing care. In this way, the participation of the individual in nursing care practices was ensured (7). In this case, although the first care moment was negative, it turned into a positive situation when the nurse learned the expectations, beliefs and feelings of the child and her parents in the following days. Communication between the nurse and the child began to increase. This situation started to increase the satisfaction of the mother and father of the child.

Caritas Processes

The caritas process is the last step towards problem solving in this model. This improvement process consists of ten steps. Caring behaviors are used in this process. These are touch, sensitivity, active listening, eye contact, comfort, honesty, respect, trust, openness, and accessibility. In a case report, care behaviors such as touch, sensitivity, active listening, eye contact, comfort, honesty, respect, trust, and openness are accessible (4). Ten individualized care approaches were applied to ten individualized healing processes in the case of uterine atony according to this model. With the care given, it was observed that the mother’s trust increased, her worries decreased and she took a more active role in the care of her baby (9). In this case report, the child and their parents were supported with a perioperative caritas processes. The child and her parents were observed in line with the results of nursing interventions.

The care given according to the Watson’s Theory of Human Caring Model offers a different approach from the care given according to the medical model. This model reflects the essence of nursing. This model focuses on healing individuals with the concept of love and compassion. The care provided by Watson’s caritas processes ensures that individuals are treated in a holistic way, and so it increases the satisfaction and safety of the individual. The positive change, satisfaction and increase in harmony observed in both the child and the family as a result of the authentic relationship established in this case report show the effectiveness of the Watson’s Theory of Human Caring Model. In addition, an example of providing holistic care in accordance with this model in pediatric surgery services is also shown. It is thought that this model will help nurses to determine the care needs of those children and their parents with corrosive esophageal injuries and to apply nursing interventions correctly. At the same time, maintaining this model-based care in all pediatric cases will help both the child and the parents to meet all their physical, psychological, emotional and spiritual needs and to provide nursing care in a holistic way. In-service training and courses should be organized to increase the awareness of nurses working in pediatrics and pediatric surgery services about nursing care based on Watson’s Theory of Human Caring Model.

Patient Perspective

The patient and her parents were happily discharged. Her parents were happy that their daughter was in a good condition. The girl was happy that she could be fed orally. Communication with the nurses became more cordial for the child.


Informed Consent: The approval concerning publication of case’s treatment and follow-up period was obtained from patient’s parents.

Peer-review: Externally and internally peer-reviewed.

Authorship Contributions

Concept and Design: N.G.Ö.Ö., F.V., Analysis and Interpretation: N.G.Ö.Ö., F.V., Literature Search: N.G.Ö.Ö., Writing: N.G.Ö.Ö., F.V., K.Y.

Conflict of Interest: The authors declared no conflict of interest.

Financial Disclosure: The authors declared that this study received no financial support.


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