Empathy in Jean Watson's Theory of Human Caring: Philosophical Reflections on the Caritas® Processes and Mindfulness

Abstract

Jean Watson's Theory of Human Caring offers a relevant and contemporary framework for holistic nursing care. By redefining traditional paradigms, Watson's model positions transpersonal care as both a theoretical and practical pathway for holistic nursing practice. Empathy, as a foundational human experience present in all care encounters, is central to the holistic development of transpersonal care. This essay explores, from classical and contemporary philosophical perspectives, the concept of empathy within Watson's framework, relating its core concepts to nurse–patient encounters in holistic care. Empathy is examined as an existential mode of being-with-the-other, articulated with concepts such as intercorporeality, comprehensive understanding of the other's experience, and becoming-other. Two of Watson's Caritas^® Processes are analyzed as spaces for holistic openness and empathic presence. The discussion highlights the importance of developing practices that transcend the technical-biological model, emphasizing the appreciation of alterity and the cultivation of dignified, sensitive, ethical, and transformative bonds in holistic care. Empathy is also discussed in relation to mindfulness, understood as an intentional practice that integrates body, mind, spirit, and heart, fostering compassionate listening. The article offers new philosophical perspectives and highlights the relevance of empathy in advancing holistic nursing care.

Introduction

Jean Watson's Theory of Human Caring proposes a comprehensive, humanistic, and holistic vision of nursing. According to Watson, nursing care goes beyond technical and biological interventions, encompassing human, spiritual, and emotional dimensions; therefore, it constitutes an ontological act of presence and communion. This is a scientific, ethical, aesthetic, and professional process in which interactions between the nurse and care recipient involve a deep physical, mental, spiritual, and sociocultural connection, giving rise to the concept of transpersonal care, which is structural in this theory and values an ethical commitment to the dignity and preservation of humanity (Gönen et al., 2017; Watson, 2008, 2012).

Watson proposes that holistic nursing represents the disciplinary path toward human caring, as it involves the integration of all aspects of being. In this context, transpersonal caring is deepened as a holistic praxis of authenticity and the ability to be present to oneself and to the other within a reflective framework. Empathy, as an intersubjective human experience, is a concept of particular relevance to Watson's work, as it enables a profound and sensitive approach to fundamental concepts of her theory (Watson, 2022).

Empathy is a spontaneous manifestation found in all human encounters and is particularly relevant in health care, where the relationships between those who suffer and those who provide care go beyond technical functions and incorporate a relational dimension (Teófilo et al., 2019). As empathy is an intersubjective experience, its connection to Watson's work is relevant, enabling a deeper, more sensitive approach to fundamental concepts of the theory, such as transpersonal caring, authentic presence and listening, and mindfulness (Sitzman & Watson, 2018).

Considered an intersubjective phenomenon, empathy has been widely discussed in phenomenology. It is treated as an experience that involves one's authentic perception of the other, maintaining the integrity of the “self” while recognizing alterity. Empathy is considered a complex human experience arising from the subjective intersection between different individuals. As beings endowed with psychophysical unity, we express feelings through our bodies and psyches, through which experiences are realized. In the encounter between two human bodies, empathy is the experience that arises in a natural, intentional, and immediate manner. From this perspective, empathic understanding involves not only the ability to “feel with” the other but also to adopt an ethical stance of receptivity and willingness to share the suffering of others (Bogalheiro, 2014; Merleau-Ponty, 2011; Ranieri & Barreira, 2012; Savieto & Leão, 2016; Stein, 2006).

Although empathy is a central concept in both philosophical and holistic nursing discourses, and Jean Watson's Theory of Human Caring has been widely discussed in the context of holistic care, no international studies to date have specifically addressed the relationship between empathy and Watson's theoretical framework. A literature search identified only two regional theoretical papers that directly discuss empathy in relation to Watson's theory (Alves et al., 2021; Savieto & Leão, 2016). In light of this gap, the present study inaugurates a new line of inquiry into how empathy is conceptualized within Watson's Science of Human Caring, inviting the academic community to deepen the philosophical and theoretical discussion on the subject.

The broader literature on empathy in nursing highlights its importance for ethical care, patient satisfaction, and the development of humanized, holistic nurse–patient relationships (Atta et al., 2024; Patterson, 2018; Watson, 2022). However, the ontological, phenomenological, and ethical dimensions of empathy remain underexplored, especially within the context of Watson's theory. Through a critical and integrative approach, this essay seeks to advance theoretical knowledge and promote critical reflection on the ethical and relational aspects.

This theoretical–philosophical paper aims to contribute to the theoretical development of Jean Watson's Theory of Human Caring by discussing, from both classical and contemporary perspectives, the relationships between empathy and the ontological and ethical foundations that underpin nurse–patient encounters within this theory. Through the integration of phenomenological and post-structural frameworks, this analysis proposes an ontological expansion of the understanding of empathy, presence, and transpersonal caring, reaffirming the holistic nursing discipline as a central epistemological matrix for nursing.

As a first step, an introductory approach to subjectivity and the human spirit will be presented, articulating metaphysical ideas with a discussion based on the ontology of care. Secondly, an analysis of the Caritas^® Processes is presented, with an emphasis on the second and fifth processes. The second Caritas^® Process, being authentically present, enabling the system of faith, hope, and belief, and honoring the subjective inner worlds of oneself and others, highlights the role of intentional presence and deep listening as pathways to the intersubjective encounter. The fifth process—fostering and accepting positive and negative feelings while authentically listening to another person's story—emphasizes the willingness to share another's suffering and vulnerability, which are essential components of understanding and an empathic attitude (Sitzman & Watson, 2018; Watson, 2008, 2012). Thirdly, this article addresses another relevant strategy in the practice of transpersonal and holistic care according to Watson: mindfulness, which helps nurses become more receptive and attentive to the emotions and needs of others, promoting active, compassionate listening (Ranieri & Barreira, 2012).

Watson's three proposals are analyzed in conjunction with the notion of empathy as sensitive presence and openness to alterity, drawing upon classical and contemporary thinkers. Theoretical and philosophical concepts of the body, corporeality, the body without organs, the vibratile body, and awareness of the lived, sensitive, and expressive body are addressed, along with their relation to the empathic experience in transpersonal care as proposed by the theorist.

Contextualizing Subjectivity, Ontology, and Empathy in Jean Watson's Theory of Human Caring

Jean Watson offers a conceptual landscape that interweaves intersubjectivity and human-to-human care with a spiritual dimension, seeking expressions of the totality of the human being. Although she does not directly declare herself a phenomenologist, her proposal is immersed in phenomenological and existential assumptions, proposing a professional stance that is not only functional but also ontological, a way of existing with others in the world (Sitzman & Watson, 2018).

By positioning care as a spiritual, aesthetic, and therefore transcendental experience, Watson moves away from a purely technical or positivist view of nursing toward an ontology of care. In this ontology, nursing can benefit from a metaphysical perspective that values the elevated spiritual sense of the human being. In a deeper, more critical way, her ontology can be related to Heidegger's notions of Dasein (in the original German) (Heidegger, 2006). Avoiding traditional theological-metaphysical language, the philosopher developed the concept of Dasein as the human mode of being, here considered similar to Watson's human being, which does not simply mean existence, but one who understands, projects, and affects oneself in the world.

Although Watson considers the spirit as an inner self or the essence of the person, the theorist does not link the sense of essence to a fixed, determined concept of human being. She understands personhood as transcending the here and now, coexisting simultaneously with the past, present, and future (Sitzman & Watson, 2018). A type of spirituality developed by Watson can be read in dialogue with Henri Bergson, for whom the spirit is not a separate substance but a continuous creating flow, inseparable from life and experience (Bergson, 1999).

Watson's concept of spirit and human being can also be related to Sartre's understanding of the human being as a constant tension between facticity; due to given historical and bodily conditions; and transcendence, as the freedom to project oneself beyond what one already is (Sartre, 2007). The philosopher defines this paradoxical coexistence between being thrown into the world and being free beyond it as the ambivalence of existing. Such ambivalence between what is given and what is to come is what makes human beings creative, ethical, and vulnerable.

Transpersonal care, as proposed by Watson, is founded on a full, authentic, intentional presence, in which the nursing professional connects with the spirit of others, embracing their inner world with sensitive, ethical openness. This form of presence enables a reciprocal communion that transcends the here and now, creating space for profound listening and a relationship that recognizes others in their totality (Ranieri & Barreira, 2012; Savieto & Leão, 2016).

From this perspective, Heidegger (2006) understands care (“Sorge” in the original German) as the primordial structure of Dasein, the human way of being that is always in relation, engaged with the world, with oneself, and with others. Care here is not an external function, a professional practice, but the very way in which human beings understand and project themselves in their possibilities. Thus, transpersonal care, as Sorge, as a way of being, acquires ontological density, constituting a way of being-with in the world that sustains the singular relational presence between caregiver and care recipient (Heidegger, 2006).

For Edith Stein (2006), empathy is an act of objective intentionality, in which the experience of the other is experienced as an expression of their alterity, without being reduced to a projection of the self. Empathy is recognized here as a co-originary phenomenon, not deduced but felt and shared in intercorporeality through intersubjective experience. By delving deeper into the theme of transpersonal care as the foundation of holistic care practice, Watson suggests that one should cultivate a soul-to-soul connection (discussed here as spirit-to-spirit), not as altruism or compassion, but as a moment of generating affect, of empathic presentification, and therefore of profound empathic understanding. This connection suggests that Watson's work is linked to the notion of empathy when considered an act of comprehensive objectification of the other's experience. Thus, nursing care is seen as a continuous creation, a space of openness to the unpredictable nature of the other, aligned with a dynamic vision in the constant becoming of subjectivity (Heidegger, 2006; Ranieri & Barreira, 2012; Teófilo et al., 2019).

Empathy in this context is not merely the recognition of the other's pain, but openness to being affected, transformed, and moved by the other. Deleuze (1997) suggests that subjectivity cannot be seen in a fixed, linear way but as a continuous becoming—a multiplicity in movement. This brings the practice of care closer to a field of forces, intensities, and affects involving the body, language, presence, morality, and desire—elements present in Watson's framework, though often described using metaphysical terminology. Thus, subjectivity, empathy, and the ontology of care constitute a fertile field of experimentation in Watson's theory, capable of redefining meanings and even promoting infinite transformative possibilities for those involved in the care relationship.

Presence and Listening as Becoming-Other: Empathy in the Caritas^® Processes

Jean Watson proposes the Caritas^® Processes as practical guides that translate the principles of Caring Science into intentional, ethical, and compassionate actions within the nurse–care relationship. Caritas is a word derived from Latin that refers to compassion, tenderness, and love and comprises a set of ten processes that guide care as a spiritual, aesthetic, and relational experience. These processes are formulated based on existential, phenomenological, and transdisciplinary presuppositions and constitute a commitment to human dignity, authentic presence, and sensitive openness to others (Gönen et al., 2017; Watson, 2008, 2012).

The second and fifth of the 10 Caritas^® Processes are the most relevant to the present study, considering their nuances regarding the phenomenon of empathy. The second process, being authentically present, is an invitation to ethical and intentional presence: to listening to the invisible that inhabits the subjectivity of the other, recognizing that care is not confined to technical interventions but is realized in the embrace of the mystery of the living person. At this level, caring constitutes a meeting of consciousness, in which the subjectivity of the other is acknowledged as a legitimate and inviolable territory where the process of care unfolds. This encounter is characteristic of what Watson calls transpersonal caring: a relational notion that transcends the egoic self and enables an ethical, spiritual, and affective connection with the interiority of the other (Watson, 2012).

Intentional presence can be understood as an act of ontological, sensitive availability. Criticizing the Cartesian dualism between body and mind, Merleau-Ponty describes total feeling as an integrated experience involving the body, consciousness, world, and the other in an indivisible unity (Merleau-Ponty, 2011). Feeling is not only a physiological process, because the body feels, thinks, and expresses itself as a whole, being itself both the subject and the object of perception. The notion of the lived body and intercorporeality thus reinforces Watson's authentic presence.

The self-body is the concept that differentiates the lived body from the objective body of Cartesian science. Total feeling arises through the self-body, with which the subject perceives something not only with a specific sense (such as sight or touch) but also when the whole body engages in the experience in an integral, affective manner. In the encounter with the self-body of the other, there is an intercorporeal dimension, an exchange that is not merely rational but also sensitive, affective, and existential (Merleau-Ponty, 2011).

In physical touch, which is essential in nurse–care recipient encounters, one does not feel with only the hands. There are implications of the entire body: an emotion, muscle tension, a gesture, a memory. Total feeling is therefore a fusion of perception, affect, and existence, by which body and world intertwine, revealing that care takes shape as an embodied, sensitive presence (Merleau-Ponty, 2011).

Watson views care as a sacred science, emphasizing that each encounter touches the other's life force. By deeply recognizing that each person is composed of a history and a connection between present and future generations, it becomes possible to understand the importance of fully and authentically honoring each life as an integral part of the cosmic whole. Being with another in an authentic way is not about dominating, interpreting, or explaining based on personal beliefs, but sustaining a space of listening and co-presence (Sitzman & Watson, 2018; Watson, 2012).

The constitution of the self always presupposes alterity: “I affirm that I am only because I know there are others”; it presupposes plurality. The way to grasp alterity is through empathy. In this context, empathy implies experiencing the other's experience in a co-originary way, as previously discussed (Stein, 2006). It involves perceiving what the other perceives and feeling what the other feels in a sui generis way, not through projection or identification, but through a comprehensive objectification of the other's experience. This understanding is not limited to the psychological domain but gains ontological breadth when linked to the notion of authentic presence.

From Heidegger's existential perspective, being in the presence of the other in their singularity involves much more than being physically present; it is about being-with then (Mitsein) in an involved, sensitive way (Heidegger, 2006). Authentic presence is realized when the caregiver is willing to inhabit the world with the other, recognizing their existence as legitimate and irreducible, even without fully understanding it. Thus, empathy, as a co-originary experience, finds one of its most ethical and silent forms of manifestation in authentic presence: being with the other, without invading them, but sustaining their existence as a presence worthy of care (Heidegger, 2006; Stein, 2006).

In contrast, the Cartesian biomedical model produces, among both professionals and patients, the fetish of the automatic correlation between subjective health needs and technical and pharmacological procedures, devices, and interventions. However, subjectivity and empathic experiences permeate human encounters, leading to either stabilization or destabilization, connection and welcoming, or even disregard and escape. In this context, authentic presence can be developed through a focus on active listening and embracing the alterity of the other in their singularity, opening oneself to the experience of empathic presentification.

Care encounters are not merely relational events but fields of becoming and transformation. Authentic presence, here also extended to empathic presence, in care is not a fixed state but a flowing process in which both caregiver and care recipient become others. Becoming, as proposed by Deleuze and Guattari, is not mimesis, identification, or product: it is a continuous process; it is the in-between. Empathic presentification can therefore be understood as an intercorporeal occurrence in which caregivers allow themselves to be affected, moved, and modified. Such an event emerges when the becoming-other is permitted to act not as a fusion, but as an ethical, affective displacement. Hence, care is becoming-affective, becoming-vulnerable, and becoming-with (Deleuze, 1997; Deleuze & Guattari, 2021).

Complementary to the second process, the fifth Caritas^® Process states the importance of “fostering and accepting positive and negative feelings while authentically listening to another person's story.” Being with the other in a nonjudgmental way should generate mutual trust and understanding. Nurses share some of the most crucial and transformative moments in the lives of others. These moments awaken the need for the expression of a wide range of feelings and emotions among all involved. Although it can be deeply challenging to witness, feel, and participate in negative expressions, it should be understood that feelings are universal and impermanent. This perception, therefore, can reframe negativity and redefine it as a productive process capable of creating events toward understanding, resolution, and deep appreciation for the experience of life (Sitzman & Watson, 2018; Watson, 2007, 2012).

It is a process of opening up to the vulnerability of the other as well as the caregiver's own (Deleuze & Guattari, 2021). In encounters in the care setting, empathy is often a risk, as it makes one available to be affected and transformed by the other's experience of suffering. The Fifth Caritas^® Process proposes a perspective of openness to the totality of the other's human experience, welcoming both positive and negative emotions as legitimate parts of existence. Therefore, it prioritizes the promotion of deep listening, seeking the recognition of emotions, without judgment, at all times in the practice of caring (Sitzman & Watson, 2018).

This process, therefore, reflects a practice of empathic listening that is founded on the suspension of judgment and the willingness to feel with and for the other. One can thus consider empathic listening to be a consubstantial, integrative, transformative act of the very experience of oneself and one's world. It can be interpreted as an experience of alterity, in which the other person's story is not merely heard but shared on an ethical, ontological level. There is always an appeal from the other that breaks into our world and demands a response; not a theoretical or moral response, but a sensitive, ethical response that is realized in care (Waldenfels, 2011).

This authentic listening finds concrete clinical expression in the psychology of the self (understood as the organizing center of subjective experience, responsible for the subject's cohesion, self-esteem, and sense of internal continuity), based on the contemporary psychoanalysis of Heinz Kohut. The author develops the introspective-empathic clinical method and defines empathy as an essential tool that enables the caregiver to access, in a neutral and objective manner, the other's interiority. In this way, interpretation, derived and modulated by empathy, is considered a cognitively more elaborate and sensitive form of listening in the clinical relationship (Kohut, 1988).

Taking empathy as therapeutic, Kohut values the essentially “affective” process of sharing an intersubjective and therefore intercorporeal and transpersonal experience. This notion deepens and legitimizes the authentic listening addressed by Watson. Through authentic, empathic listening, the pain of the other can offer restorative recognition, becoming a form of care that transforms because it does not judge but embraces. Empathic listening transcends mere communication technique; it serves as a means to comprehend and connect with another's interiority without judgment, hasty interpretation, or reduction to external classifications (Hummel, 2001; Kohut, 1959).

In this encounter, empathy is not merely a means but a form of ontological presence: the caregiver, by sustaining this relational space, legitimizes the other's subjectivity as an expression of the sacred human. Authentic presence, in this context, is not reduced to an abstract ideal but manifests itself concretely in the listening that welcomes, the word that comforts, the silence that respects, and the intention to be with the other.

All listening is always embodied and situated. When listening to the other, we are affected by their sensitive physical and spiritual presence and by what is manifested in their lived expression. Authentic listening is welcoming the other in their sensitive and emotional corporeality, recognizing alterity as a legitimate presence in the shared space of caring (Bogalheiro, 2014).

Thinking about the body in the sensitive presence of the other's body—both in authentic presence and in authentic empathic listening—can be analyzed within the field of subjectivity and the production of desire, which refers to what Deleuze and Guattari identify as the search for the body without organs (BwO; Deleuze & Guattari, 2021). As an experience lived by subjects as desiring machines (who always express desire), the BwO is a practice, not a concept: it is an exercise, an inevitable experimentation, a field of immanence where nothing is lacking to desire, and which, thus, no longer relates to any external or transcendent criterion.

In a radical way, the idea of having a BwO to open oneself to a caring intersubjective encounter is to replace patient history with forgetting and interpretation through experimentation. This BwO can then reveal itself for what it is: through the connection of desires, conjunction of flows, and continuum of intensities. Listening authentically and empathically is to open oneself up to the field of immanence of desire in its own plane of consistency, through which the caregiver, despite experience and wisdom, is not the one who provides the answer, but the one who does not permit forgetting the questions: what really are the bodies and ideas that are suitable? What are the affects of authentic joy? What are the desires and empathic experiences that the other makes arise in me? (Deleuze & Guattari, 2021; Teixeira, 2010).

Therefore, instead of encounters mediated by agencies of power, authoritarian formations, or discourses that reduce the body to illness as natural history, the empathic encounter is a territory of desire and sensation, of affections (capacity to affect and be affected), of a body without organs: a body of encounter, a virtual body whose actuality is realized in the lived body (Barreira, 2014; Ceccim & Merhy, 2009).

Mindfulness and Empathic Presentification for Encounters in the Care Setting

Watson has recently explored another central concept, known as mindfulness. The theorist uses this concept to propose practices that aim to cultivate the understanding of her theory among nursing professionals. Transpersonal care requires authenticity and the ability to be present for oneself and the other in a reflective framework. Therefore, mindfulness is a personal practice that enables caregivers to sustain a deep, ethical, transformative, relational presence (Sitzman & Watson, 2018).

Watson's notion of mindfulness is based on the original proposal of the Buddhist meditative tradition of the monk Thich Nhat Hanh, who conceptualizes it as the energy of being aware and awake to the present moment, enabling one to see deeply into the nature of phenomena and cultivate true presence before all that is. It is a spiritual and ethical exercise of inner and outer reconciliation, in which each breath and gesture becomes an opportunity to care for oneself and the other. The most widely accepted international concept of mindfulness indicates that full attention arises from purposefully paying attention to the present moment in a non-judgmental way. Watson reinforces this understanding and reintegrates it into the context of nursing as a spiritual-scientific practice, in which the caregiver becomes a space of silent welcoming for the legitimate expression of the other (Kabat-Zinn, 2003; Nhat Hanh, 1999; Sitzman & Watson, 2018).

Mindfulness practices in healthcare settings have been widely used in some countries, particularly in the USA. The government of the UK recommends this practice for the prevention and management of stress. Numerous studies with different theoretical and practical approaches have been conducted. The main practice is more traditionally known as mindfulness-based stress reduction. Some of these studies quantitatively analyze changes related to the experience of empathy before and after the implementation of practices developed in the short, medium, and long term, obtaining moderate results (Burton et al., 2017; Iikura et al., 2025; Kriakous et al., 2021).

Fuochi and Voci (2020) offer a deeper reflection on the traits of mindfulness and the relationship with empathy, understanding that such aspects operate through complex cognitive and affective processes. The authors take meditative practices as an example, which are considered important here in the context of mindfulness developed by Watson, and analyze how such practices promote de-reification (ceasing to treat sensations and thoughts as permanent concrete realities), detachment (not fixating on inner emotional experiences), and decentering (the ability to observe one's own thoughts without clinging to them, thus avoiding the occurrence of centralizing rumination). These mechanisms act as mediators for empathic perspective-taking and concern while also reducing personal suffering.

Regarding rumination, while mindfulness reduces repetitive negative thoughts (which favors empathy), these same excessively ruminated thoughts can interfere with the relationship between full attention and empathic sensitivity. Additionally, other authors discuss emotional regulation, showing that mindfulness strengthens adaptive strategies in the face of emotions, such as cognitive reassessment or neutral attention, thus strengthening the practice of empathy (Chambers et al., 2009).

In summary, mindfulness would contribute to empathy in a multifaceted way: not only by inspiring empathic presence and listening, but also by reorganizing internal processes. In this way, it can reduce fusion with emotions, promote detachment, control rumination, and strengthen emotional regulation, thus creating the conditions for sensitive, compassionate, holistic, and non-invasive listening in both clinical practice and human care (Chambers et al., 2009).

However, such cognitivist theories can be placed in check when the horizon of human experience is broadened through concepts such as Thich Nhat Hanh's interbeing (Hanh, 1992), which proposes that no being exists in isolation; empathy as an experience that occurs spontaneously, naturally, and therefore involuntarily, co-originary, and sui generis (Stein, 2006; Teófilo, 2019; Teófilo et al., 2019); and the vibratile body as a body sensitive to affections, permeable to the world and to others in a profound and informative way (Hanh, 1992).

Upon perceiving that the true nature of the human being is relational (one exists only in connection with all other beings, as interbeings), it is not a matter of “feeling for” or “understanding” the other “rationally,” but of recognizing that we are affected because we are part of the other. Regarding empathy as a lived experience, Stein's description of the degrees of empathic experience (Stein, 2006) provides fertile ground for a deeper understanding of the bodily and spiritual development of empathic listening and presence.

In the first degree of empathy, there is the immediate experience of something that presents itself before me. In the second degree, the meaning that this experience offers (the intentional content it carries) is grasped. In the third degree, a comprehensive clarity of this experience occurs, at which point empathic “presentification” is established: not in an originary way, but as an actualization of the other's experience within me. This process is a movement in which what is experienced does not belong to me in the first person but is given to me as presence, enabling me to understand what the other experiences, even if I do not experience it in the same way. Thus, alterity remains preserved, but, at the same time, it is co-originarily accessed by empathic “presentification,” which brings to my consciousness the other's way of being as a living being (Ranieri & Barreira, 2012; Stein, 2006).

In the encounter between nurse and care recipient, there exists a motivational element that effectively positions them to engage with the experience of empathic “presentification.” In this encounter, by becoming present and listening without judgment, it is necessary to empty oneself to hear the other, because the other's body is never inexpressive. Empathy constitutes a core, though not exclusive, aspect of human experience. To be empathically present is a state of consciousness through action that cannot be falsified, for one who is not empty does not listen, exerts unnecessary effort, and disconnects from the other's experience (Barreira, 2014).

An empathic bond is formed in these encounters. Thus, bonds of trust and affection can be created. Such trust can be established through concrete actions, such as gestures, a gaze, listening, attention, words, and all manifestations that indicate authentic empathic presence and listening. However, when care is exercised violently, when eyes are averted, or when words are not spoken, trust can be lost, transforming the care relationship into one of struggle, anguish, indifference, and fear in both parties. The subjective intensities experienced in healthcare, whether with individuals capable or not of fluid communication (such as people with cognitive-mnestic impairments), evoke in healthcare professionals multiple constructions of desire, territorializations, and deterritorializations. These experiences can often blur or confuse emotional responses, especially in situations where a cure is impossible or communication is impaired (Rolnik, 2020).

Therefore, the practice of mindfulness can support the welcoming of the subjective intensities present in encounters, allowing one to empty oneself without exclusion, without attempting to become an inert body, but instead to be fully and authentically present: a vibratile body. Suely Rolnik's concept of the vibratile body seeks to understand a body with the capacity to reach the invisible, reacting to encounters with other beings (human or otherwise) through intensities, vibrations, sensations of attraction and repulsion, emotion, and expression—a body that functions as a force field, vibrating intensely when in contact with flows of external forces. The encounter provokes bodily and subjective changes, which make the body a territory of creation, of the construction of meaning, and of the transformation of the subject. The body vibrates, feels, connects with other presences, and changes, paving the way for a field of creation (Gineste & Pellissier, 2008; Rolnik, 2011).

Practices of meditation-based mindfulness can cultivate love and moments of transpersonal care. For Watson, mindfulness sustains the Caritas^® Processes. To exemplify what we have called the practice of emptying, Watson uses the metaphor of a blue sky: thoughts and emotions are the passing clouds in a mutable image of the sky, whereas mindfulness reconnects us with the stable background of consciousness. This image reveals the affective and spiritual support role that the caregiver plays: being with the other without automatically reacting to what emerges, enabling the other's experience to blossom at its own pace (Sitzman & Watson, 2018; Watson, 2007, 2012).

Therefore, emptying, as opposed to de-reification, decentering, detachment, or any pursuit of cognitive regulation, can be a gesture of ethical self-reflexivity, in which the caregiver seeks to suspend the automatisms of action and, in pursuit of the desires of their own vibratile body and the vibratile body of the other, sustain the relational space as an experience of empathic “presentification.” Instead of reacting, the caregiver remains, permitting the other's experience to emerge in its own density. This suspensive, open listening does not seek to correct but to recognize. In this recognition, the possibility of a care arises that does not impose itself but rather offers itself as a space of creation for the other being (Gineste & Pellissier, 2008).

Recommendations for Practice

Based on the understanding of empathy as an embodied, sensitive, and transformative presence, several strategies are suggested for deepening the ethical, aesthetic, and holistic aspects of nursing care. Empathic and holistic attentive care is not limited to technical or communication skills but rather requires the cultivation of ontological, affective, and holistic dispositions that can support authentic listening and openness to alterity, as well as the embracing of one's own vulnerability and that of the other.

One possibility suggested by Watson is the use of reflective journals guided by the Caritas^® Processes as tools for self-training and self-care. Empathy circles may also be developed as psychosocial and non-pharmacological interventions to promote the intentional practice of empathy, grounded in authentic presence and listening (Niezink & Rutsch, 2016). Such practices favor the development of suspensive listening and the recognition of suffering as a constitutive part of the encounter with the other (Watson, 2012). Another strategy is the adoption of moments of structured silence before delicate clinical procedures, creating an internal space of presence and intentionality in the caregiver—not as a religious or protocol-driven ritual, but as a transition from technical functions to ethical connection (Halifax, 2009).

It is important to create institutional environments that welcome the practice of contemplation, mindfulness, and shared listening, retrieving the spiritual and aesthetic dimension of care, which is often silenced in technical contexts (Sitzman & Watson, 2018). These spaces, whether physical or symbolic, can serve as territories of subjectivation, in which the completeness of the caregiver and the singularity of the care recipient are preserved.

Lastly, the caregiver's body should be recognized as a vibratile and relational surface, capable of feeling, affecting, and being affected. From this holistic perspective, care ceases to be merely a functional response to a demand; it is also listening to intensities, openness to becoming, and a presence that supports, without anticipating, the emergence of the other (Hanh, 1992).

Final Reflections: Toward an Articulation of Empathy with Watson's Theory of Human Caring

At the core of Watson's theoretical framework lies the notion of transcendence—not merely as a metaphysical ideal, but as a lived relational process that elevates both caregiver and patient beyond the immediacy of suffering toward deeper meaning, healing, and wholeness. Thus, authentic transpersonal caring transcends the physical and technical dimensions of nursing, engaging instead with the existential and spiritual aspects of human experience, aiming for a deconstruction of the positivist paradigm.

Aiming for new paradigms for the future of holistic nursing, empathy emerges as a fundamental mediating force between two transcendent processes: the caregiver's intentional presence and the patient's capacity for existential transformation. Empathy understood not as emotional contagion but as a disciplined and reflective energy directed toward the lived experience of the other, enables the nurse to enter the patient's subjective world without losing professional boundaries.

This empathic engagement, through empathic listening and presence, fosters a transpersonal connection that is neither reducible to the psychological nor merely affective, but ontological: anchored in the recognition of shared humanity and mutual vulnerability. Through empathy, the nurse becomes a mediator of transcendence, facilitating the patient's movement from loneliness and despair toward integration and hope.

Thus, empathy functions as a dynamic bridge: it links the nurse's intentional caring consciousness to the patient's existential openness, allowing both to participate in a co-created therapeutic encounter. In Watson's model, this empathic mediation is not accidental but essential, it is the mechanism through which the Caritas^® Processes unfold, enabling the realization of human dignity and spiritual growth.

Furthermore, empathy resists commodification: it cannot be standardized or mechanized and therefore asserts itself as a counterpoint to technocratic models of care. It requires presence, receptivity, and moral courage, qualities cultivated through reflective practice and philosophical inquiry. In this sense, empathy is both a method and a moral stance, a powerful epistemological concept that allows nurses to perceive suffering in all its complexity and an ethical imperative that calls them to respond with integrity. By mediating between the caregiver's transcendental intentionality and the patient's transformative potential, empathy becomes one of the central pillars of Watson's vision of a holistic care paradigm rooted in humanistic values and existential depth.

Although this work does not extend to direct empirical investigation, its main contribution lies in the in-depth philosophical and conceptual analysis of the relationship between empathy and Jean Watson's Theory of Human Caring within the field of holistic nursing. By articulating ontological, phenomenological, and ethical foundations, this study advances the theoretical development of Watson's framework, reaffirming its relevance as a living and continually evolving discipline.

Through the integration of classical and contemporary philosophical perspectives, empathy is reinterpreted and situates the Science of Human Caring within a broader epistemological horizon, in which caring is manifested as a moral, relational, and spiritual act grounded in the dignity of the human encounter. These reflections may provide a basis for subsequent theoretical and empirical inquiries in holistic nursing science.

Limitations

Although this paper presents an in-depth theoretical and philosophical analysis of empathy within Jean Watson's Theory of Human Caring, it recognizes as a limitation the absence of a broader discussion grounded in the holistic nursing literature and holistic care practices. Related concepts such as authentic presence, mindfulness, and transpersonal caring were not explored in direct articulation with empirical holistic nursing scholarship and clinical application. The extensive body of holistic nursing research on empathy, patient-centered care, and the outcomes of holistic interventions was also not included, as the primary purpose of this paper was to deepen new philosophical perspectives to enrich the ontological and epistemological foundations of Watson's theory for holistic nursing practice.