THEORETICAL FOUNDATIONS OF NURSING | NCMA110
Prof: Annabelle Flores (BSN 1-YA-1)
Transcriber: Bernadette G. Castañares
Lesson 1: Evolution of Nursing
I. Period of Intuitive Nursing
- Prehistoric- Early Christian Era (Medieval Period)
Nursing was “untaught” and instinctive. It was performed out
of compassion for others and desire (out of the wish) to help
others.
Beliefs and Practices of Prehistoric Man
- Nursing belonged to women taking care of the children, the
sick, and the aged.
- Illness causes the attack of evil spirit through the use of black
magic (voodoo)
- Medicine man (shaman)- witch doctor with white magic
- Trephining- drilling hole with a rock in the skull w/o
anesthesia (drive away spirits)
Contributions to Medicine and Nursing Babylonia
- Code of Hammurabi- provided laws covering every facet of
Babylonian life
● medical practice; specific doctors per disease
● patient’s right to choose from charms, medication or surg
procedures
A. Egypt —------------------------------------------------------------------
-introduced the ‘art of embalming’
-developed keen observation that left 250 records of
recognized disease
-slaves and patient’s families nursed the sick
B. Israel —------------------------------------------------------------------
-Moses, “Father of Sanitation,” wrote in Old Testament
which:
-(Genesis) emphasized the practice of hospitality to
strangers and acts of charity
C. China —------------------------------------------------------------------
-Belief: girl’s clothes for male babies drive evils away
-prohibited cadaver dissection as ancestral worship
-gave birth to pharmacology (materia medica)
D. India —-------------------------------------------------------------------
-Men of medicine built hospitals, practiced an intuitive form
of asepsis (exclusion of bacteria: i.e., sterile), and were
proficient in the practice of medicine and surgery
-Sushurutu- made the list of nurse’s functions and
qualification w/c became the first reference to the nurse’s
taking care of patients.
-Now: the insertion of IV cannulas is for doctor’s task only
E. Ancient Greece —----------------------------------------------------
-Nursing- the task of an untrained slave
-Caduceus- insignia of the medical profession today was
introduced
-Hippocrates- “Father of Scientific Medicine” made major
advances by rejecting the belief that disease is caused by
the supernatural; developed assessment standards for
clients, established overall medical standards and
recognized a need for nurses.
-Realization that doctors need nurses
F. Rome —------------------------------------------------------------------
-maintains vigorous health (illness=weakness)
-care of the ill was left to the Greek physicians or slaves
who were inferior to Roman society.
II. Period of Apprentice Nursing
-Middle Ages; nursing care was done by crusaders,
prisoners…
-Nursing became the work of the least desirable of
women–prostitutes, alcoholics, prisoners
-Florence Nightingale received her 3-month course of study in
nursing.
-Founding of religious nursing orders to 1836 when
Kaiserswerth Institute for the training of Deaconesses in
Germany was established (by Pastor Theodore Fliedner and
his wife, Frederika)
a. Period of “on the job” training
b. Nursing care was performed without any formal
education and by people who were directed by
more experienced nurses
c. Religious orders of the Christian church were
responsible for the development of this kind of
nursing
Crusades--------------------------------------------------------------------
● Military religious orders started hospitals ran with
men
● Knights of Lazarus- founded primarily for the lepers in
Jerusalem after being conquered by the Christians; Rise
of Secular Orders
● Religious taboos and soc restrictions influenced
nursing during Religious Nursing orders
● Older Nuns: prayed and cared for the sick. Younger
Nuns: washed soiled linens in rivers.
● 16th Century: hospitals (last resort) were established but
gloomy, cheerless, airless, and unsanitary
III. Period of Educated Nursing
-June 15, 1869, Florence Nightingale School of Nursing
was opened until WWII.
------
1. The development of nursing was strongly shaped by
trends from wars, arousal of social awareness, freedom
of women, and increased opportunities opened to
women.
2. Popularization of the Nightingale System Philosophy
-Importance of Nursing Ed
-Nurses teaching students
-Specialization developed
3. Facts: Florence Nightingale
● Born: May 12, 1820, Florence, Italy
● “Lady with a Lamp”, “Mother of Modern Nursing”
● Raised in England; Learned languages, lit, math, and
soc graces
● Self-appointed goal: “to change the profile of nursing”
● Led the nurses who cared of wounded during the
Crimean War
● 2 Published Books: Notes on Nursing / Notes on
Hospitals
THEORETICAL FOUNDATIONS OF NURSING | NCMA110
Prof: Annabelle Flores (BSN 1-YA-1)
Transcriber: Bernadette G. Castañares
IV. Period of Contemporary Nursing
-20th century; Post WWII to present
-Licensure of nurses started
-Specialization of Hospital and diagnosis
-Training of Nurses in diploma program
-Development of baccalaureate and advanced degree program
a. Scientific and technological developments; social changes
b. Establishment of WHO by the United Nation
c. Use of atomic/nuclear energy for med Dx and Tx
d. Utilization of computers (utilized-data collection, teaching,
diagnosis, inventory, payrolls, record keeping, and billing.)
e. Use of advanced equipment for Dx and PT
f. Health- fundamental human right
g. Nursing involvement in community health is strengthened
h. Development of the expanded role of nurses
i. Professionalization of nursing
Nursing in the Philippines Early Beliefs and Practices
-Causation of disease (evil spirits, enemy or witch)
-Evil spirits could be driven away by a person that can expel
demons
-Special gods of healing; priest-physician and Herbolarios
-Herbmen or Herbicheros as one who practiced witchcraft
-unidentified disease believed to be bewitched
V. Spanish Period
-The religious orders exerted their efforts to care for the sick by
building hospitals in the different parts of the Philippines----------
------Nursing during the Philippine Revolution
-Late 1890’s: the war between the Philippines and Spain
caused a significant number of casualties… Many women
took the role of nurses to assist wounded soldiers.
-Philippines Red Cross- brought due to the emergence of
Filipina nurses
Prominent Persons Involved in Nursing Works
a. Josephine Bracken- Rizal’s wife, installed the first
hospital in an estate house in Tejeros; provided nursing
care to the wounded night and day
b. Rosa Sevilla de Alvero- converted their house into
quarters for the Filipino soldiers, during the
Philippine-American War (1899).
c. Dona Hilaria de Aguinaldo- Emilio’s 1st wife, organized
Filipino Red Cross under the inspiration of Apolinario
Mabini
d. Dona Maria Agoncillo de Aguinaldo- Emilio’s 2nd wife,
provided nursing care to Filipino soldiers throughout the
revolution. President of Filipino Red Cross branch in
Batangas
e. Melchora Aquino a.k.a. “Tandang Sora”- Nursed the
wounded Filipino soldiers and gave shelter and food.
f. Capitan Salome- a revolutionary leader in Nueva Ecija;
provided nursing care to the wounded when not in
combat
g. Agueda Kahabagan- the revolutionary leader in Laguna,
also provided nursing services to her troops
h. Trinidad Tecson- “Ina ng Biac na Bato '', stayed in the
hospital at Biak na Bato to care for the wounded soldiers.
Hospitals and Nursing Schools
-1907: Americans began training the first Filipino nursing
students.
-Curriculum in the Philippines “was never a mirror-image
reproduction of the American nursing curriculum”
1. Iloilo Mission Hospital School of Nursing
(Iloilo City, 1906)
-It was run by the Baptist Foreign Mission Society of
America. In March, 1944, 22 nurses graduated; in April
1944, graduate nurses took the first Nurses Board
Examination at the Iloilo Mission Hospital.
2. St. Paul’s Hospital School of Nursing (Manila, 1907)
-Established by the Archbishop of Manila, the Most
Reverend Jeremiah Harty under the supervision of the
Sisters of St. Paul de Chartres. It was located in
Intramuros and it provided general hospital services with
a free dispensary and dental clinic.
3. Philippine General Hospital School of Nursing (1907)
-Anastacia Giron-Tupas, the first Filipino chief nurse and
superintendent in the Philippines ü St. Luke’s Hospital
School of Nursing (Quezon City, 1907)
Significance of Nursing Theory
Discipline VS. Profession
● Discipline- specific to
academia; branch of educ,
department of learning, or
domain of knowledge.
● Profession- specialized
field of practice founded on the
theoretical structure or the
science of knowledge of that
discipline and accompanying
practice abilities.
Lesson 2: History and Philosophy
of Science
History of Nursing Theory
● Begun with Florence Nightingale
● FN envisioned women as a body of educated women
even if they are not educated or employed
● Establishment of the School of Nursing in St. Thomas
Hospital in London marks the birth of modern nursing
● FN pioneered in nursing practice and education; her
writing became a guide at the beginning of 20th century
for establishing the school of nursing in the US.
● Nightingale(1859-1969), the vision of Nursing been
practiced for a century
● Theory development evolved rapidly, leading to
recognition of nursing as an academic discipline with a
specialized body of knowledge
THEORETICAL FOUNDATIONS OF NURSING | NCMA110
Prof: Annabelle Flores (BSN 1-YA-1)
Transcriber: Bernadette G. Castañares
● In the mid-1800, recognize the difference between
nursing and medicine and describe nurse function in
putting the patient in the best condition of nature(GOD).
The care of the sick is based on the knowledge of the
person and the environment
Curriculum Era
● Addressed the content on what nurses should study to
learn how to become a nurse
● Emphasizes what courses nursing should take to arrive
at a standardized curriculum
● The idea of moving nursing education from
hospital-based diploma programs into colleges and
universities began to emerge during this era (Erwin,2015;
Judd & Sitzman, 2013).
● In the 1930, a standardized curriculum was published
and adopted by diploma nursing program
● It emphasizes course selection and content for the
nursing program and recognition of the role of research
in scientific knowledge development and the goal of
acquiring knowledge to guide nursing practice- and the
curriculum gives way to Research Era
Research Emphasis Era
● Started in the mid 20th century, more nursing leaders
embraced higher education- came to understand the
scientific age and research path to new nursing
knowledge
● Nurses begins to participate in research and is included
in the curriculum in early graduate nursing program
● In 1970, The first journal of nursing research been
evaluated and reveals that it lacks conceptual/ theoretical
framework
Graduate Era
● MAN (Master’s Degree in Nursing) emerged to meet the
needs of nurses as specialist for clinical practice
● Nursing masters program include courses in Concept
development and Nursing model introducing students to
early nursing theorist and knowledge development
● Nurse researchers works to develop clarify a specialized
body of knowledge with the goal to improve the quality of
patient care, providing professional practice style,
achieving and recognition as a profession
Theory Era
● Doctoral program began to develop with strong emphasis
on theory development and testing; It was a natural
outgrowth of the research and graduate education eras
● The Theory provides a framework for curricula and
advanced practice guides begins to be recognize
● In 1980, major development in nursing Theory leading to
transition from the pre paradigm to paradigm period in
nursing.
● Nursing paradigm(model) provides a perspective for
education, research, administration, and further theory
development
Significance of Nursing Theory
● Significance for the Discipline- Discipline is specific to
academia and refers to the branch of education,
department of learning, or a domain of knowledge;
dependent on theory for its continued existence.
● Nursing can be a vocation or nursing can be a
discipline with a professional style of theory-based
practice.
● Commitment to theory-based evidence for practice is
beneficial to patients in that it guides systematic,
knowledgeable care.
● *Nursing Doctoral programs begin to open to provide
nursing knowledge
● The role of conceptual framework in research design for
the production of science which led to theory
development and move nursing forward to new nursing
knowledge for nursing practice
● Nursing conceptual framework was used to organize
curricula in nursing programs and recognized as a model
that addresses concept and values of nursing
Significance of the Profession
-Profession refers to a specialized field of practice, founded
on the theoretical structure of the science and knowledge of
that discipline and accompanying practice abilities.
● The criteria for a profession is the application of nursing
knowledge in practice
● The commitment to theory-based evidence for practice
provides benefits for patient guided by systematic and
knowledgeable care
● It serves the profession as Nurse being recognize by its
contribution to the health care of society
● Nursing theory being recognize as tool for reasoning,
critical thinking, decision making required for quality
nursing practice
History and Philosophy of Science
Rationalism
● Rationalism epistemology (scope of knowledge)
emphasizes PRIORI reasoning as the appropriate
method of advancing knowledge
● The Rationalist view is evident with the work of
Einstein, a theoretical physicist made use of
mathematical equation in developing theories
● The theories constructed offered an imaginative
framework
● If someone believes that science is a process of
inventing descriptions of phenomena, the appropriate
approach to theory construction
Empiricism
● The Empiricist view is based on the central idea that
scientific knowledge is derived from sensory experience
● Bacon believe that scientific truth was discovered
through generalizing observed facts, this approach is
known as inductive reasoning, based on the idea that
the collection of facts precedes attempts to formulate
generalization
THEORETICAL FOUNDATIONS OF NURSING | NCMA110
Prof: Annabelle Flores (BSN 1-YA-1)
Transcriber: Bernadette G. Castañares
Early 20th Century Views of Science and Theory
● During the first half of the century , Philosophers
focus on the analysis of theory structure, Scientist
focused on the empirical approach
● Positivism was first used by Comte, who emerged as
the dominant view of modern science. Positivists
believed that empirical research and logical analysis (
deductive and inductive) were approaches used to
produce scientific knowledge
Emergent Views of Science and Theory in the Late 20th
Century
● In the late 20th century, several authors presented
analyses challenging the positivist position. Offering a
new perspective of science
● One of the perspectives in new philosophy emphasizes
science as a process of continuing research rather than
a product focused on findings.
● The emergent epistemology, the emphasis shifted to
understanding scientific discovery and process as
theories change overtime
● Empiricist view phenomena objectively, collects data,
and analyze it to inductively proposed theory
Lesson 3: Structure of Nursing
Knowledge
The Structure of Knowledge in the Discipline of Nursing
● Metaparadigm- meta (with), paradigm (pattern)-- of
shared understanding and assumption
● It includes broad conceptual boundaries of nursing
knowledge, and discipline (health, environment, person,
and nursing)
● The concepts and propositions of a meta paradigm is
admittedly extremely global and provide no definitive
direction for such activities, research, and clinical
practice.
Philosophy
● Nursing Philosophy- most abstract type; set forth the
meaning of nursing phenomena through analysis,
reasoning, and logical presentation.
● The function of philosophy is to communicate what the
members of a discipline believe to be true in relation
to the phenomena of interest to that discipline, what they
believe about the development of knowledge about those
phenomena, and what they value with regard to their
actions and practices
Nursing Conceptual Methods------------------------------------------
● Nursing conceptual models comprises nursing works by
theorists referred to by some as pioneers in nursing.
● The term conceptual model is synonymous with the
terms: conceptual framework, conceptual system,
paradigm, and disciplinary matrix.
Functions of a Conceptual Model-------------------------------------
● Provides a distinctive frame of reference
● How to observe and interpret the phenomena of interest
to the discipline
● Simplification of the reality of concepts that the model
author considers relevant and as aids to understanding
● Provides a structure and a rationale for the scholarly
and practical activities of its adherents, who comprise a
subculture or community of scholars within a discipline
● Conceptual model gives direction to the search for
relevant questions about the phenomena
Conceptual Model of Nursing
● We all use models to guide our actions, be it the way we
conduct our personal lives or the way we nurse.
● These are based on the beliefs and values of family,
friends, peers, and those we respect or those who have
influenced us greatly.
● They are the explicit and formal presentations of some
nurses’ implicit, private images of nursing.
The Nursing Theory
● The Nursing Theory derived its work from nursing
philosophies, conceptual models, grand theories,
abstract nursing theories, or works in other
disciplines
● Purpose of Nursing Theory
-Education
-Research
-Clinical Practice
Grand Theories------------------------------------------------------------
● Grand theories are abstract, broad in scope, and
complex, therefore requiring further
research for clarification.
● Grand nursing theories do not provide guidance for
specific nursing interventions but rather provide a
general framework and ideas about nursing.
THEORETICAL FOUNDATIONS OF NURSING | NCMA110
Prof: Annabelle Flores (BSN 1-YA-1)
Transcriber: Bernadette G. Castañares
● Grand nursing theorists develop their works based on
their own experiences and the time they were living
explaining why there is so much variation among
theories.
● Address the nursing metaparadigm components of
person, nursing, health, and environment.
Middle-range Theory------------------------------------------------------
● Middle-range theory, is more limited in scope (as
compared to grand theories) and presents concepts and
propositions at a lower level of abstraction.
● They address a specific phenomenon in nursing.
● Due to the difficulty of testing grand theories, nursing
scholars proposed using this level of theory.
● Most middle-range theories are based on the works of
a grand theorist but they can be conceived from
research, nursing practice, or the theories of other
disciplines.
Definition of a Theory----------------------------------------------------
● A theory is a notion or an idea that explains experience,
interprets observation, describes the relationship, and
suggests outcomes. Parsons (1949) quoted by nursing
theorists, wrote that theories help us know what we
know and decide what we need to know.
● The theories are mental patterns of frameworks
created to help understand and create meaning from our
experience, organize and articulate our knowledge, and
ask questions leading to new insights.
Components of Nursing Theories
● Phenomenon- describe an idea or response about an
event, a situation, a process, a group of events, or a
group of situations. It may be temporary or permanent.
Nursing theories focus on the phenomena of nursing.
● Concepts- help describe or label phenomenon. They
are words or phrases that identify, define, and establish
structure and boundaries for ideas generated about a
particular phenomenon. Concepts may be abstract or
concrete.
● Interrelated concepts define a theory.
ABSTRACT CONCRETE
(mentally constructed) (directly experienced)
Transport Wheelchair, stretcher, and
hospital bed
Cardiovascular Diseases Stroke, MI (Myocardial
Infarction)
Nurse Competency Parenteral injection, IV
(intravenous) cannulation,
NGT (nasogastric tube),
enema, and catheterization
● Assumptions. Assumptions are accepted as truths and
are based on values and beliefs. These are statements
that explain the nature of concepts, definitions, purpose,
relationships, and structure of a theory.
● Definition- Conveys general meaning and reduce
vagueness in understanding a set of concept
● Linkages and Ordering- Development of theoretical
linkages provides an explanation of why the variables
are connected in a certain manner; that is, the
theoretical reason for particular relationships
Theory Development
● Theory development in nursing is an essential
component in nursing scholarship to advance the
knowledge of the discipline
● Nursing theories that clearly set forth an understanding
of nursing phenomena
● (self-care, therapeutic communication, chronic sorrow)
guide scholarly development of the science of nursing
through research
Analysis of a Theory
● Analysis, critique and evaluation are methods used to
study nursing theoretical works critically.
● Analysis of theory is carried out to acquire knowledge
of theoretical adequacy.
● It is an important process and the first step in applying
nursing theoretical works to education research,
administration or practice.
● Analysis process is useful for learning about the works
and is essential for nurse scientists who intend to test,
expand, or extend the works.
● Understanding the theoretical framework is vital to apply
it in practice.
Criteria in the Analysis of Theory-------------------------------------
● Clarity. It speaks to the meaning of a term used, and
definitional consistency and structure speak to the
consistent structural form of terms in the theory.
● It discusses degrees of simplicity and calls for simple
forms of theory (middle range, guide practice.)
● Generality speaks to the scope of application and the
purpose of the theory ( Chinn & Krammer, 2015).
● Accessible addresses the extent to which empiric
indicators for the concepts can be identified and to what
extent the purposes of the theory can be attained
● Importance. Does this theory create an understanding
that is important to nursing
Characteristics of a Theory---------------------------------------------
1. A theory must be “falsifiable.”
2. A theory must be simple in terms of the general
principles involved.
3. It must be workable
4. Must be elegant/beautiful (Symmetry, Simplicity, Accuracy)
5. The theory should be as general as possible.
6. It should have few or no anomalies
7. If possible, the theory ought not to be purely statistical.
8. The theory should bring out analogies and use models
THEORETICAL FOUNDATIONS OF NURSING | NCMA110
Prof: Annabelle Flores (BSN 1-YA-1)
Transcriber: Bernadette G. Castañares
Lesson 4:
-Components of Nursing Theory (L#3)
Relational Statements- define the relationships between
two or more concepts. They are the chains that link concepts
to one another.
Purposes of Nursing Theories
● The primary purpose of theory in the profession of
nursing is to improve practice by positively
influencing the health and quality of life of patients.
Nursing theories are also developed to define and
describe nursing care, guide nursing practice, and
provide a basis for clinical decision-making.
● The accomplishments of nursing in the past led to the
recognition of nursing in an academic discipline,
research, and profession.
In Academic Discipline--------------------------------------------------
● Much of the earlier nursing programs identified the major
concepts in one or two nursing models, organized the
concepts, and build an entire nursing curriculum around
the created framework.
● The unique language in these models was typically
introduced into program objectives, course objectives,
course descriptions, and clinical performance criteria.
● The purpose was to explain the fundamental
implications of the profession and to enhance the status
of the profession.
In Research -----------------------------------------------------------------
● Development of theory is fundamental to the research
process where it is necessary to use theory as a
framework to provide perspective and guidance to the
research study.
● Theory can also be used to guide the research process
by creating and testing phenomena of interest. To
improve the nursing profession’s ability to meet societal
duties and responsibilities, there needs to be a
continuous reciprocal and cyclical connection with theory,
practice, and research.
● This will help connect the perceived “gap” between
theory and practice and promote theory-guided practice.
In Profession --------------------------------------------------------------
● Clinical practice generates research questions and
knowledge for theory.
● In a clinical setting, its primary contribution has been
the facilitation of reflecting, questioning, and thinking
about what nurses do. Because nurses and nursing
practice are often subordinate to powerful institutional
forces and traditions, the introduction of any framework
that encourages nurses to reflect on, question, and think
about what they do provides an invaluable service.
Classification of Nursing Theories
There is different ways to categorize nursing theories. They are
classified depending on their function, levels of abstraction, or
goal orientation.
By Abstraction
There are three major categories when classifying nursing
theories based on their level of abstraction: grand theory,
middle-range theory, and practice-level theory.
*Grand Theory and Middle-Range Theory- discussed in L#3
Practice-Level Nursing Theories--------------------------------------
● Practice nursing theories are situation-specific theories
that are narrow in scope and focus on a specific patient
population at a specific time.
● Practice-level nursing theories provide frameworks for
nursing interventions and suggest outcomes or the
effect of nursing practice.
● Theories developed at this level have a more direct
effect on nursing practice as compared to more
abstract theories.
● These theories are interrelated with concepts from
middle-range theories or grand theories.
Lesson 5A
Florence Nightingale- Environmental Theory
● Was born in Florence, Italy on May 12, 1820. Died on
Aug. 13, 1910, in London
● British nurse, and statistician; who founded the
philosophy of modern Nursing
● She was in charge of nursing the wounded soldier during
the Crimean war; spent many hours in the ward giving
personal care to the wounded and established her name
as Lady of the Lamp
● Formalizes nursing education led her to establish, the
school of nursing in St. Thomas Hospital in London, 1860
● Linked health in 5 environmental factors (pure/fresh
air, pure water, efficient drainage, cleanliness, light)
● Stress the importance of keeping the client warm,
maintaining a noise-free environment, and attending to
the client’s diet in terms of assessing intake, timelines of
the food, and its effect on the person
THEORETICAL FOUNDATIONS OF NURSING | NCMA110
Prof: Annabelle Flores (BSN 1-YA-1)
Transcriber: Bernadette G. Castañares
10 Aspects of the Environmental Theory
1. Patients should have clean air and a
temperature-controlled environment
2. Patients should have access to direct sunlight and not
be subjected to unnecessary noise, mostly when
sleeping
3. Rooms should be kept clean
4. Hospital facilities should be well-constructed
5. Bedding should be changed and aired frequently
6. Patients should be offered a variety of scenery, such
as new books or flowers, to prevent boredom
7. Nurses should be positive but not offer false hope to
patients or make light of their illness
8. Patients should be kept clean and nurses should wash
hands frequently
9. Offer a variety of small meals instead of large ones,
and do not do patient care while the patient is eating
as it is distracting
10. Consider not only the individual patient but the context
of where he or she lives
What are your 2 cents?
The Hospital Window
The Four Metaparadigms of Environmental Theory
1. Person- In Florence Nightingale’s theory, the Person,
one of the elements in the four metaparadigms, is the
individual receiving care
● Nightingale’s perception of the Person is that the
person is a multidimensional being, that includes
biological, psychological, social, and spiritual
components
● Biological - addressed by the use of medicine and
nursing to address various diseases
● Psychological and social components - consists
of self-concept, feelings, thought-processes and
social interactions
● Spirituality- intertwined with Nightingale’s own
spiritual beliefs; that the person is valued
**Nightingale theory of the Person is based on—Holism-
concern of integrating the biological, social, psychological, and
spiritual with its environment
------------------------------------------------------------------------------------
2. Health- Health is viewed as the combined result of
environmental, psychological, and physical factors, not
just the absence of disease.
● Nightingale:t “health is not only to be well but to
be able to use well every power we have.”
● This is consistent with our perception of health
today, where one does not have to be disease free
to be healthy but to maximize their potential to be in
a healthy state.
● Disease- dys-ease (absence of comfort.)
● Nightingale isolated 5 factors essential in securing
an individual’s health; these include pure air, pure
water, efficient drainage, cleanliness, and light
Nightingale’s 6 D’s of “Dys-ease”
3. Environment- five environmental components which
are all essential to an individual’s health. These are
known collectively as the “health of houses”, and
outline factors of the physical environment that must
receive attention
● The underlying principle of maintaining the health of
houses is to put the patient in a condition that is
best for nature to act upon him or her. An
environment that promotes health allows the
patient to retain their energy, or “vital powers” for
use towards self-healing
THEORETICAL FOUNDATIONS OF NURSING | NCMA110
Prof: Annabelle Flores (BSN 1-YA-1)
Transcriber: Bernadette G. Castañares

4. Nursing- Nightingale’s view on nursing is one that is
largely intertwined with factors pertaining to the
environment.
● Nightingale believed that many of the symptoms
and sufferings of patients were not directly related
to their disease or ailment, but rather
consequences of poor environmental conditions
● The duties of nursing include providing essentials
such as fresh air, warmth, light, cleanliness, quiet,
and a proper diet. By helping to control
environmental influences, nurses can aid in the
maintenance of the health of their patients.
Case Study
● Undergraduate and graduate degrees in nursing and
psychiatric-mental health nursing and Ph.D. in
educational psychology and counseling.
● Six (6) Honorary Doctoral Degrees.
● Research has been in the area of human caring and
loss.
● In 1988, her theory was published in “nursing: human
science and human care”.
The Theory of Transpersonal Caring
10 carative factors- each has a dynamic phenomenological
component that is relative to the individuals involved in the
relationship as encompassed by nursing.

You are caring for an 82-year-old woman who has been

hospitalized for several weeks for burns that she sustained on
her lower legs during a cooking accident. Before the time of
her admission, she lived alone in a small apartment. The
patient reported on admission that she has no surviving family.
Her support system appears to be other elders who live in her
neighborhood. Because of transportation difficulties, most of
them are unable to visit frequently. One of her neighbors has
reported that she is caring for the patient’s dog. As you care
for this woman, she says that none of the other nurses have
listened to her about a such visit. As she asks you about this,
she begins to cry and tells you that they have been separated.
You recall that the staff discussed their concern about this
woman’s well-being during the report that morning. They said
she has been eating very little and seems to be depressed.

Lesson 5B
Jean Watson
"We are the light in institutional darkness, and in this model, we
get to return to the light of our humanity." -Dr. Jean Watson

➢ (June 10, 1940 – present) Margaret Jean Harmon

➢ grew up in the small town of Welch, West Virginia, in the
Appalachian Mountains (youngest of eight children)
➢ surrounded by an extended family–community
environment
➢ high school (West Virginia); the Lewis Gale School of
Nursing in Roanoke, Virginia, where she graduated in
1961.

● Educated: BSN, University of Colorado, 1964, MS,

University of Colorado, 1966, Ph.D., University of
Colorado, 1973
● Distinguished Professor of Nursing and Chair in
Caring Science at the University of Colorado Health
Sciences Center.
● Fellow of the American Academy of Nursing.
● Dean of Nursing at the University Health Sciences
Center and President of the National League for Nursing
THEORETICAL FOUNDATIONS OF NURSING | NCMA110
Prof: Annabelle Flores (BSN 1-YA-1)
Transcriber: Bernadette G. Castañares
The Ten Caritas Practices
1. Cultivating the practice of loving-kindness and
equanimity toward self and others as a foundation to
Caritas consciousness
2. Being Authentically Present- Enabling, sustaining, and
honoring faith, hope, and deep belief system and the
inner subjective world of self/other
3. Cultivation of one’s own spiritual practices and
transpersonal self, going beyond ego-self
4. Development and sustaining a helping trust caring
relationship
5. Being present to, and supportive of, the expression of
positive and negative feelings
6. Creative use of self and all ways of knowing as part of
the caring process; engage in the artistry of Caritas
nursing
7. Engage in genuine teaching-learning experience that
attends to unity and being and subjective meaning-
Attempting to stay within other’s frame of reference
8. Creating a healing environment at all levels
9. Administering sacred nursing acts of caring and
healing by tending to basic human needs
10. Opening and attending to spiritual/mysterious and
existential unknowns of life-death.
The Seven Assumptions
1. Caring can be effectively demonstrated and practiced
only interpersonally.
2. Caring consists of carative factors that result in the
satisfaction of certain human needs.
3. Effective caring promotes health and individual or
family growth.
4. Caring responses accept a person not only as he or she
is now but as what he or she may become.
5. A caring environment is one that offers the development
of potential while allowing the person to choose the best
action for himself or herself at a given point in time.
6. Caring is more “healthogenic” than curing. A science of
caring is complementary to the science of curing.
7. The practice of caring is central to nursing.
Transpersonal Caring Theory Metaparadigm
➢ Person- Watson uses interchangeably the terms human
being, person, life, personhood, and self. She views
the person as “a unity of mind/body/spirit/nature”
- Watson states, “I make the point to use mind, body,
soul or unity within an evolving emergent world
view-connectedness of all, sometimes referred to as
Unitary Transformative Paradigm-Holographic
thinking.
➢ Health- She defined health as “unity and harmony
within the mind, body, and soul”; associated with the
“degree of congruence between the self as perceived
and the self as experienced”
- Watson’s definition of health has evolved. The
positive state of physical, mental, and social
well-being with the inclusion of 3 elements;
1. A high level of overall physical, mental, and social
functioning
2. A general adaptive maintenance level of functioning
3. Absence of illness
➢ Environment- Watson speaks to the nurse’s role in the
environment as “attending to supportive, protective, and
or corrective mental, physical, societal, and spiritual
environments”
- She emphasizes the person and the environment
have a connection, nurses are part of the patient’s
environment and once a nurse enters the patient’s
room an expectation is already present.
➢ Nursing- “Nursing is concerned with promoting health,
preventing illness, caring for the sick and restoring
health”
- According to Watson, the word nurse is both a noun
and a verb. To her, nursing consists of “Knowledge,
thought, values, philosophy, commitment and action
with some degree of passion”
Case Study
A 62-year-old inmate is admitted to this hospital from prison
with a complaint of chest pain. The patient is being worked
up for possible myocardial infarction and admitted to the
cardiac unit. Because the patient is an inmate, while he is in
the hospital a prison guard will be posted outside of the
patient’s room and the patient will be handcuffed to the bed
rail. During the initial assessment, the admission nurse finds
the patient to be withdrawn. The nurse discovers the patient
has a past medical history significant for abuse of multiple
substances. The patient describes behaviors that led to his
incarceration and estrangement from his family. The patient
expresses to the nurse interest in meeting with a chaplain
while in the hospital.
Lesson 5B
Patricia Benner
➢ born in Hampton, Virginia, and spent her childhood in
California; received her early and professional education.
➢ obtained a baccalaureate of arts degree in nursing
from Pasadena College in 1964.
➢ 1970: she earned a master’s degree in nursing, with a
major emphasis in medical surgical nursing from the
University of California, San Francisco School of Nursing
➢ Her Ph.D. in stress, coping, and health was conferred
in 1982 at the University of California, Berkeley, and her
dissertation was published in 1984.
➢ Benner has a range of clinical experience, including
acute medical-surgical, critical care, and home health
care.
THEORETICAL FOUNDATIONS OF NURSING | NCMA110
Prof: Annabelle Flores (BSN 1-YA-1)
Transcriber: Bernadette G. Castañares
Novice to Expert Theory
Benner adapted Hubert Dreyfus's Model of skill acquisition.
Benner applied it to her work “ From novice to Expert” Benner’s
model is situational and describes five levels of skill
acquisition and development.
Major Concepts and Definition----------------------------------------
● Novice- The person has no background experience in
the situation in which he or she is involved. Context-free
rules and objective attributes must be given to guide
performance.
- Students like us
- teach theory; practice by utilizing to relative
● Advanced Beginner- The person can demonstrate
marginally acceptable performance, having coped with
enough real situations to note, or to have pointed out by
a mentor, the recurring meaningful components of the
situation. Nurses functioning at this level are guided by
rules and are oriented by task completion.
- Fresh grad; guided by the rules
- knowledgeable but doesn’t have in-depth exp
● Competent- Consistency, predictability, and time
management are important in competent performance.
These are nurses w/ 3 yrs exp.
- Recognize patterns
- Prioritize
- Devise new rules and plans
- Less supervision
- High Anxiety
● Proficient- Nurses at this level demonstrate a new ability
to see changing relevance in a situation, including
recognition and implementation of skilled responses to
the situation as it evolves. Nurses are more confident
with their knowledge and abilities.
- w’ 3-5 yrs experience; managing problem abt dean,
doctors, and supplies moves fast and accurate
● Expert- Nurses have an intuitive grasp of the situation,
and being able to identify the region of the problem
without losing time considering a range of alternative
diagnoses and solutions. Expert nurses “know the
patient” even w/eyes closed. (5yrs+ exp)
- Key aspects of an expert nurse
*Demonstrating a clinical grasp and resource-based
practice
*Possessing embodied know-how
*Seeing the big picture
*Seeing the unexpected
Metaparadigm
➢ Nursing- Described nursing as a caring relationship,
an enabling condition of connection and concern. Caring
is primary because caring sets up the possibility of giving
help and receiving help. Nursing is viewed as a caring
practice whose science is guided by the moral art and
ethics of care and responsibility
➢ Person- The body of a person has 5 dimensions,
Benner pointed out that nurses should attend to all
these dimensions of the body and seek to understand
the role of embodiment in a particular situation of health
illness and recovery
➢ Health- is defined as what can be assessed, whereas
well being is the human experience of health or
wholeness. Health is described as not just the absence
of disease and illness. A person may have the disease
and not experience illness, because illness is the
human experience of loss or dysfunction, whereas
disease is what can be assessed at the physical level
➢ Situation- Benner and Wrubel use the term situation
rather than environment because situation conveys a
social environment with social definition and
meaningfulness. The person’s past, present, and future,
which include her or his own personal meanings, habits,
and perspectives, influence the current situation.
Lesson 5C
Katie Eriksson
● Born on Nov 18, 1943, in Jakobstad, Finland; belongs to
the Finland Swedish minority in Finland, and her native
language is Swedish
● She is a 1965 graduate of the Helsinki Swedish
School of Nursing, and in 1067 she completed her
public health nursing specialty education in the
same institution.
● After taking nursing instructor at Helsinki Swedish
Medical Institute. She currently works as a professor of
health sciences at Abo Akademi University in Vaasa
● A master's degree program in health sciences, and a
4-year postgraduate studies program leading to a
doctoral degree in health sciences
Eriksson’s Contribution to Nursing Theory: Theory
Caritative Caring
➢ This model of nursing distinguishes between caring
ethics, the practical relationship between the patient
and the nurse, and nursing ethics.
➢ Nursing ethics are ethical principles that guide a
nurse's decision-making abilities
➢ Caritative caring consists of love and charity which is
also known as Caritas, and respect and reverence for
human holiness and dignity
➢ According to the theory, suffering that occurs as a result
of a lack of caritative care is a violation of human dignity
THEORETICAL FOUNDATIONS OF NURSING | NCMA110
Prof: Annabelle Flores (BSN 1-YA-1)
Transcriber: Bernadette G. Castañares
Major concepts and definition-----------------------------------------
Caritas
- Means love and charity. In Caritas, eros and agape are
united, and Caritas is by nature unconditional love.
- Caritas, which is the fundamental motive of caring
science, also constitutes the motive for all caring.
Caring Communion
- Caring communion constitutes the context of the
meaning of caring and is the structure that determines
caring reality.
- It is a form of intimate connection that characterizes
caring
- Caring communion requires meeting in time and space,
an absolute, lasting presence
The Act of Caring
- contains the caring elements (faith, hope, love, tending,
playing, and learning)
- Involves the categories of infinity and eternity, and
invites to deep communion
- The act of caring is the art of making something very
special out of something less special
Caritative Caring Ethics
● Comprises the ethics of caring, the core of which is
determined by the Caritas motive.
● Caring ethics deals with the basic relation between the
patient
● It is about the approach we have toward the patient
caring ethics deals with the basic relation between the
patient and the nurse-the way in which the nurse meets
the patient in an ethical sense
Dignity
● Constitutes one of the basic concepts of caritative
caring ethics
● Human dignity is partly absolute dignity, partly relative
dignity
Invitation
● Refers to the act that occurs when the caregiver
welcomes the patient to the caring communion
Suffering
● Suffering is an ontological concept described as a
human being’s struggle between good and evil in a state
of becoming
● suffering implies in some sense
Suffering Related to Illness, to Care, and to Life
3 different forms of suffering
1. Suffering related to illness is experienced in connection
with illness and treatment
2. Not to be taken seriously, not to be welcome, being
blamed
3. Being subjected to the exercise of power are various
forms of suffering related to care
The Suffering Human Being
➢ The suffering human being is the concept that uses to
describe the patient
➢ The patient is a suffering being who suffers and patiently
endures
Reconciliation
● Refers to the drama of suffering
● Implies a change through which a new wholeness is
formed of the life the human being has lost in suffering
● Reconciliation is a prerequisite of caritas
Caring Culture
- Is the concept that Eriksson (1987) uses instead of
environment.
- It characterizes the total caring reality and is based on
cultural elements such as traditions, rituals,basic values
Metaparadigm
A. Person------------------------------------------------------------------
➢ Human being- fundamentally a religious being, holy, and
constant becoming; they are constantly changing and
therefore never in a state of full completion
➢ fundamentally dependent on communion; dependent on
another; (relationship bet a concrete other human being
and abstracted other (some form of god))
➢ Caring context: they become a patient in the original
sense of the concept--a suffering human being
B. Environment---------------------------------------------------------
➢ The ethos of caring science, as well as that of caring,
consists of the idea of love and charity and respect and
honor of the holiness and dignity of the human being
➢ Ethos is the sounding board of all caring, there is an
"inner ought to," a target of caring
➢ Ethos- home; place where a human being feels at home
➢ Ethos and ethics belong together, and in the caring
culture, they become one
C. Health----------------------------------------------------------------
➢ Health as soundness, freshness, and well-being.
➢ Implies being whole in body, soul, and spirit
➢ Health- the pure concept of wholeness and holiness
➢ Different dimensions of health as "doing", "being", and
becoming with wholeness that’s unique to human beings
D. Nursing----------------------------------------------------------------
➢ Caritas constitutes the inner force that is connected with
a mission to care
➢ A caregiver beams forth what at Eriksson calls Caritas or
the strength and light of beauty
➢ The fundamentals of natural caring are constituted by the
idea of motherliness, which implies cleansing and
nourishing, and spontaneous and unconditional love
➢ Emphasizes that caritative caring relates to the
innermost core of nursing. She distinguishes between
caring nursing from nursing care; she means that nursing
care is based on the nursing care process and it
represents good care only when it is based on the
innermost core of caring
THEORETICAL FOUNDATIONS OF NURSING | NCMA110
Prof: Annabelle Flores (BSN 1-YA-1)
Transcriber: Bernadette G. Castañares
THEORETICAL FOUNDATIONS OF NURSING | NCMA110
Prof: Annabelle Flores (BSN 1-YA-1)
Transcriber: Bernadette G. Castañares