NURSING PHILOSOPHIES

FLORENCE NIGHTINGALE
Modern Nursing
• credentials and background
• Founder Of Modern Nursing
 Environmental Problems

1. Lack of sanitation
2. Presence of filth –
contaminated water and bed
linens
3. Soldiers exposure to
frostbite, louse infestations,
wound infections and
opportunistic diseases.
• The lady of/WITH the lamp –
because she made ward rounds
during the night
• In Scutari she became critically ill
with crimean fever – typhus or
brucellosis
• After the war – she established st.
thomas hospital and kings college
hospital In London.
Major Assumptions
1. Nursing – Every woman at one time in her life would be a nurse in the
sense that nursing is being responsible for someone else’s health.
2. Person – Patient. The nurse was in control of and responsible for the
patient’s environmental surroundings.
3. Health – Being well and using every power to the fullest extent. She
envisioned the maintenance of health through prevention of disease
by environmental control and social responsibility.
4. Environment – Nursing was to assist nature in healing the patient.
Create and maintain a therapeutic environment. Her assumptions and
understanding about the environmental conditions were most relevant
to her philosophy.
• The role of nursing is to facilitate "the body’s reparative
processes" by manipulating client’s environment.
Theoretical Assertions
• Disease was a reparative process
• Disease was nature’s effort to remedy a process of poisoning
or decay or a reaction against the conditions in which a person
was placed.
MAJOR CONCEPTS & DEFINITIONS
• Theory focused on environment. (Surroundings)
• Five essential components of environmental health
• Pure air
• Light
• Cleanliness
• Efficient drainage
• Pure water
1. PURE AIR – “Keep the air he breathes as pure as the external air, without chilling
him”
• Emphasis on proper ventilation
• Measuring the patient’s body temperature through palpation of extremities to check for
heat loss.
• good fire, opening windows and properly positioning the patient.
2. LIGHT – direct sunlight. To achieve the beneficial effects of sunlight, nurses were
instructed to move and position patients to expose them to sunlight.
3. CLEANLINESS – patient, nurse and environment. A dirty environment was a source
of infection through the organic matter it contained.
4. EFFICIENT DRAINAGE – appropriate handling and disposal of bodily excretions and
sewage were required to prevent contamination of the environment.
5. PURE WATER – advocated bathing the patients on a frequent, even daily basis. Also
the nurse must bathe daily, their clothing to be clean and wash their hands frequently.
Acceptance by the Nursing Community
1. Practice – remain the foundation of nursing practice today.
2. Education – three experimental schools were established in
the US in 1873
• Bellevue Hospital in New York
• New Haven Hospital in Connecticut
• Massachusetts Hospital in Boston
- good practice could result only from good education
3. Research – empirical approach to solving problems of health
care delivery.
- “Environmental Theory”
Jean Watson
Philosophy and Theory of Transpersonal Caring
• Margaret Jean Harman Watson
• Born and grew up in Welch, West Virginia
• University of Colorado BSN in 1964, Master’s Degree in 1966
and doctorate degree in 1973.
Books
1. Nursing: The Philosophy and Science of Caring (1979) – 10
Carative Factors
Theoretical Sources
• Caring moment can be transpersonal – each person feels a
connection with the other at the spirit level.
• Healing – directly related to the individual’s evolving
personhood.
• She uses handwashing as a ritual to pause for a moment and
become receptive to interactions with the patient.
• “the Caring Moment is most evident within the transpersonal
Caritas energetic field model.”
• One’s consciousness, intentionality, energetic heart-centered presence
is radiating a field beyond the two people and situation, affecting the
larger field
• four aspects of caring – moral ideal, intentionality, ontological
competencies, healing art and healing space in transpersonal caring
Theoretical Assertions
• NURSING – Consist of knowledge, thought, values, philosophy,
commitment and action with some degree of passion. Using the 10
carative factors, the nurse provides care to various patients.
• PERSONHOOD – views person as a unity of mind/body/spirit/nature.
The body is a living spirit that manifests one’s being in the world
• HEALTH – unity and harmony within the mind, body and spirit,
associated with the degree of congruence between the self as
perceived and the self as experienced.
• ENVIRONMENT – healing spaces can be used to help others
transcend illness, pain and suffering. The aim of the environment is to
create healing places.
Marilyn Anne Ray
Theory of Bureaucratic Caring
• Marilyn Anne Dee Ray was born in
Hamilton, Ontario, Canada.
• Graduated from St. Joseph Hospital
School of Nursing in 1958.
• She finished her BSN and MSN at
University of Colorado School of Nursing
– she met Dr. Madeleine Leininger.
Theoretical Sources
• Ray’s interest in caring as a topic was stimulated by her work
with Leininger in 1968 focusing on transcultural nursing and
ethnographic-ethnonursing research methods.
• she used ethnographic methods in combination with
phenomenology and grounded theory to generate substantive
and formal grounded theories, resulting in the theory of
bureaucratic caring.
Major Concepts and Definitions
• Caring is A complex, transcultural, relational process, grounded in
an ethical, spiritual context. Caring is inevitable within a culture or
society, such as, personal culture, hospital organizational culture,
and society culture.
• Physical - this factor is related to the physical state of being, which
includes, biological and psychological patterns. The reason is that,
both the human mind and body are interrelated, showing a pattern
that influences the other.
• Economic - related factors of the definition of caring include money,
budget, insurance systems, limitations, and guidelines imposed by
managed care.
• Person – spiritual and cultural being
• Health – is not simply the consequences of a physical state of
being
• Nursing - Holistic, relational, spiritual and ethical caring that
seeks the good of self and others in complex community,
organization and bureaucratic sources.
Theory of Bureaucratic Caring
• Caring in nursing is contextual and is influenced by the
organizational structure.
• The theory emphasizes the holistic nature of an organization
rather than simple cause-effect relationships of individual
actions.
• Spiritual-ethical caring by nurses, the ultimate goal of which is
the promotion of well-being through caring, has a positive effect
on health care organizations and can become an economic
resource.
Patricia Benner
Caring, Clinical Wisdom and Ethics in Nursing Practice

• Patricia E. Benner, R.N., Ph.D., FAAN is a professor emerita

at the University of California, San Francisco.
• Born in Hampton, Virginia.
• Ba in Nursing - Pasadena College/Point Loma College
• MS in med/surg nursing from UCSF
• Phd -1982 from UC Berkeley
• AN AMERICAN MULTI AWARDED NURSE LEADER,
WRITER, &RESEARCHER, RANKED AS THE 4TH MOST
INFLUENTIAL NURSE BY THE READERSHIP OF THE
JOURNAL NURSING STANDARD IN THE UNITED
KINGDOM.
Philosophy
• A philosophy of nursing who believes that “ the nurse-patient
relationship is not a uniform, professionalized blueprint but
rather a kaleidoscope of intimacy in some of the most dramatic,
poignant, & mundane moments of life”
• Benner adapted the Dreyfus model to clinical nursing practice.
The Dreyfus brothers developed the Skill Acquisition model by
studying the performance of chess masters and pilots in
emergency situations.
• Benner’s model is situational and describes five levels of skill
acquisition and development: (1) novice, (2) advanced
beginner, (3) competent, (4) proficient, and (5) expert.
• Benner’s approach to knowledge development that began with
from novice to expert began a growing, living tradition for
learning from clinical nursing practice through collection and
interpretation of exemplars.
• major concepts
• NURSING- NURSING IS VIEWED AS A CARING PRACTICE WHOSE
SCIENCE IS GUIDED BY THE MORAL ART & ETHICS OF CARE &
RESPONSIBILTY.A CARING RELATIONSHIP, AN ENABLING CONDITION OF
CONNECTION & CONCERN.NURSING PRACTICE AS THE CARE & STUDY
OF THE LIVED EXPERIENCE OF HEALTH, ILLNESS, & DISEASE
• PERSON - A PERSON IS A SELF- INTERPRETING BEING, THAT IS, THE
PERSON DOES NOT COME INTO THE WORLD PREFEFINED BUT GETS
DEFINED IN THE CLOURSE OF LIVING A LIFE.
• HEALTH - HEALTH IS DEFINED AS WHAT CAN BE ASSESSED, WHEREAS
WELL-BEING IS THE HUMAN EXPERIENCE OF HEALTH OR WHOLENESS.
• ENVIRONMENT - SHE BELIEVES THAT THE TERM SITUATION IS TO BE
USED RATHER THAN ENVIRONMENT.PERSONAL INTERPRETATION OF
THE SITUATION IS BOUNDED BY THE WAY THE INVIDUAL IS IN IT OF PAST
, PRESENT, & FUTURE.SITUATION/ BEING SITUATED CONVEYS A SOCIAL
ENVIRONMENT WITH SOCIAL DEFINITION & MEANINGFULNESS
KATIE ERIKSSON
THEORY OF CARITATIVE CARING
• Eriksson was born on November 18,
1943, in Jakobstad, Finland.
• 1965 graduated at the Helsinki
Swedish School of Nursing,
• 1967 completed her Public Health
Nursing specialty education.
Caritative Caring
• Caritas refers when caring for the human being in health
suffering.
• True caring, occurs when the one caring in a spirit of caritas
alleviates the suffering of the patient.
• It is not equated to service with quality and compensation.
• Love- Charity-faith-hope
Published Books
• The Idea Of Caring
• The Suffering Human Being
• THE BASICS IN CARITATIVE CARING ETHICS ARE:
• HUMAN DIGNITY
• CARING COMMUNION
• INVITATION & RESPONSIBILITY
Major Assumptions
• Nursing – viewed as love and charity
• Person – human being is an entity of body-soul and spirit
• Environment - ETHOS/HOME, HUMAN BEING’S INNERMOST
SPACE WHERE IT APPEARS NAKEDNESS.
• Health - soundness, freshness, & well being
Karl Marie Martinsen
Philosophy of Caring
• A NORWEGIAN NURSING THEORIST
STANDS PROVOCATIVELY IN THEIR
COUNTRY ON A DEBATE THAT
NURSING EDUCATION CURRICULUM
WILL BE CHANGED TO 4 year degree.
• A philosophy of nursing which stand for
“nursing’ is founded on caring for life, on
neighbourly love.
• One of her major social & nursing
concerns while practicing was social
inequalities in general & in the health
service in particular .
Contributions and Writings
• CARING, NURSING & MEDICINE: HISTORICAL-
PHILOSOPHICAL ESSAYS.
• MORAL PRACTICE & DOCUMENTATION IN PRACTICAL
NURSING.
Philosophy of Caring
• THE METAPARADIGM THAT REFERS: NURSING COULD BE
CALLED THE “ TRINITY OF CARING”
• CARING IS FUNDAMENTAL TO NURSING & TO OTHER
WORK OF A CARING NATURE - metaparadigm
• ACCORDING TO THIS THEORY, THE THREE COMPONENTS
OF “TRINITY OF CARING” ARE OF THE FOLLOWING.
• relational
• practical
• moral
Major Concepts
• Person – the body is a unit of soul and flesh
• Health – it does IT DOES NOT ONLY REFLECT THE
CONDITION OF THE ORGANISM, IT IS ALSO AN
EXPRESSION OF THE CURRENT LEVEL OF COMPETENCE
IN MEDICINE
• Environment - IN SPACE ARE FOUND TIME, AMBIENCE, &
POWER
NURSING CONCEPTUAL
MODELS
Myra Estrin Levine
• Myra Estrin Levine proposed four principles of
conservation. The process by which
conservation is achieved is adaptation and the
desired outcome is integrity or wholeness.
Adaptation includes responses based on past
experiences (historicity), specific to the need
(specificity), and with a variety of levels of
possible response (redundancy). The principles
of conservation relate to the conservation of
energy, structural integrity, personal integrity,
and social integrity of the individual.
Three major concepts

• Wholeness (Holism)
• Adaptation
• Conservation
• psychosocial assessment should focus on – information needed
to plan appropriate treatment
• nursing diagnosis – need for conservation
Wholeness
• To understand the whole person, one must first understand the
parts of the whole. Levine used Erickson’s description of
wholeness as an open system she believed that humans
respond in “ an integrated, singular fashion to environmental
changes”
• this should be the goal of all nursing care.
 Adaptation

• Adaptation is the process of change whereby the individual retains

his integrity within the realities of his internal and external
environment” .All adaptations vary in degree, and not all are
successful.Conservation is the outcome.Adaptation has three
characteristics
• Historicity
• Specificity
• Redundancy
Conservation Model of Nursing
• Adaptation – critical for conserving wholeness in the midst of
constant environmental change.
• Nursing care focuses on the management of integrated hoslistic
responses like:
1. Fight or flight
2. Response to stress
3. Sensory response
• Trophicognosis – the proposal of the usage of the term to use
as the scientific method to develop a nursing care judgment as
an alternative to nursing diagnosis.
Conservation
• “Conservation describes the way complex systems are able to
continue to function even when severely challenged (Levine,
1973).The primary goal of conservation is maintaining wholeness
and uniqueness.Nursing actions reflecting this model are directed
at helping the client conserve
• principles:
• Energy - fatigue
• Personal Integrity – losing control of the situation
• Structural Integrity
• Social Integrity – sharing your feelings to supportive people
 Martha Rogers
Science of Unitary Beings
• Martha Roger’s theory Science of Unitary Human Beings is mainly focusing
on the four concepts and principles of homeodynamic that are
• energy fields
• openness,
• pattern,
• pandimensioal,
• integrality,
• resonancy,
• and helicy
 Major Concepts

• Rogerian model – abstract system of ideas from which from

which to approach the practice of nursing. It stresses the
totality of experience and existence that is relevant in todays
health care system.
• critical thinking pattern three components:
The Science of Unitary Human Beings
• It specifies a worldview and
philosophy used to identify the
phenomena of concern to the
discipline of nursing .
• She postulated that human beings
are dynamic energy fields that are
integral with environmental fields
• Today she is thought of as “ahead of
her time, in and out of this world.
• unitary human beings - The term that refers the irreducible,
indivisible, pandimensional energy field identified by pattern and
manifesting characteristics that are specific to the whole.
• environmental field - The term that refers the irreducible,
indivisible, pandimensional energy field identified by pattern and
integral with the human field.
• passive health - terms to symbolize wellness and the absence
of disease and major illness.
Imogene King
Theory of Goal Attainment
• “Nursing is a process of action, reaction
and interaction by which nurse and
client share information about their
perception in a nursing situation” and “a
process of human interactions between
nurse and client whereby each
perceives the other and the situation,
and through communication, they set
goals, explore means, and agree on
means to achieve goals.”
 Assumptions
• (1) The focus of nursing is the care of the human being (patient).
• (2) The goal of nursing is the health care of both individuals and groups.
• (3) Human beings are open systems interacting with their environments
constantly.
• (4) The nurse and patient communicate information, set goals mutually, and
then act to achieve those goals. This is also the basic assumption of the
nursing process.
• (5) Patients perceive the world as a complete person making transactions with
individuals and things in the environment.
• (6) Transaction represents a life situation in which the perceiver and the thing
being perceived are encountered. It also represents a life situation in which a
person enters the situation as an active participant.
Major Concepts
• NURSING -  Is a process of action, reaction, and interaction whereby
nurse and client share information about their perceptions in the
nursing situation.
• HEALTH - Is a dynamic life experience of a human being, which
implies continuous adjustment to stressors in the internal and external
environment through optimum use of one’s resources to achieve
maximum potential for daily living.
• PERSON – INDIVIDUAL - Are social beings who are rational and
sentient. 
• ENVIRONMENT - Is the background for human interactions. It is both
external to, and internal to, the individual.
Interacting System
• Personal system - perception, self,
growth and development, body image,
space, and time.
• Interpersonal system - interaction,
communication, transaction, role, and
stress.
• Social system - organization, authority,
power, status, and decision making.
Dorothea Orem
Theory of Self-Care- (grand theory)
• Self care - it demonstrates practices of all
the activities that individual’s initiate and
perform on their behalf in maintaining life,
health and well being.
• The ability to perform self-care actions is
called Basic Conditioning Factors.
• What is the condition that indicates
that a person needs nursing care?
Universal self-care requisite:
• Maintenance of sufficient intake of air.
• Maintenance of sufficient intake of food.
• Prevention of hazards to human life, human
functioning, and human well-being.
• NURSING SYSTEM - is considered to be the
unifying theory that includes all of the
essential elements of self-care deficit nursing
theory.
Major Concepts
• Human being – humanity - an integrated whole composed of an
internal physical, psychological and social nature with varying
degrees of self care ability 
• Health - as a state of well being, which refer to a person's condition of
existence, characterized by contentment, pleasure, happiness,
movement towards self ideals.
• Nursing - its an art through which the practitioner of nursing gives
specialized assistance to persons with disabilities that needed greater
than ordinary assistance to meed the daily needs for self care
• Environment - the surrounding of the patients may affect their ability to
perform their self-care activity.
DOROTHY JOHNSON
BEHAVIORAL SYSTEM MODEL
• Dorothy first proposed her model of nursing care in
1968 as fostering of “the efficient and effective
behavioral functioning in the patient to prevent
illness". 
• She also stated that nursing was “concerned with man
as an integrated whole and this is the specific
knowledge of order we require”. 
• In 1980 Johnson published her conceptualization of
“behavioral system of model for nursing”where she
explains her definitions of the behavioral system
model.
 4 ASSUMPTIONS OF THE SYSTEM
• First, there is “organization, interaction, interdependency and integration of the parts
and elements of behaviors that go to make up the system ” 
•  A system “tends to achieve a balance among the various forces operating within
and upon it', and that man strive continually to maintain a behavioral system balance
and steady state by more or less automatic adjustments and adaptations to the
natural forces impinging upon him.” 
• A behavioral system, which both requires and results in some degree of regularity
and constancy in behavior, is essential to man that is to say, it is functionally
significant in that it serves a useful purpose, both in social life and for the individual. 
• Last, “system balance reflects adjustments and adaptations that are successful in
some way and to some degree.”.
Sister Callista Roy
Adaptation Model of Nursing
•  Sister Callista Roy model sees the individual as a set of
interrelated systems who strives to maintain a balance between
various stimuli.
 Major Concepts
• Person - humans are holistic beings that are in constant interaction with
their environment.
• Environment - is defined as conditions, circumstances, and influences that
affect the development and behavior of humans as an adaptive system.
• Focal stimuli are that which confronts the human system and requires the most
attention. 
• Contextual stimuli are characterized as the rest of the stimuli that present with
the focal stimuli and contribute to its effect. 
• Residual stimuli are the additional environmental factors present within the
situation, but whose effect is unclear. This can include previous experience with
certain stimuli.
• Health - is defined as the state where humans can continually
adapt to stimuli.
• Nursing - nurses are facilitators of adaptation.
• Adaptation - is the “process and outcome whereby thinking and
feeling persons as individuals or in groups use conscious
awareness and choice to create human and environmental
integration.”
• Internal Process
• Regulator subsystem – physiological coping
• Cognator subsystem – mental coping
Four Adaptive Modes
1. Physiological-physical mode
2. Self-concept group identity mode
3. Role function mode
4. Interdependence mode
Levels of Adaptation

1. Integrated process
2. Compensatory process
3. Compromised process
The Four Major Concepts 
• “Human being” as having two major systems, the biological system and the
behavioral system. It is role of the medicine to focus on biological system
where as nursling's focus is the behavioral system. 
• “Society” relates to the environment on which the individual exists. According to
Johnson an individual’s behavior is influenced by the events in the environment
• “Health” is a purposeful adaptive response, physically mentally, emotionally,
and socially to internal and external stimuli in order to maintain stability and
comfort.
• “Nursing” has a primary goal that is to foster equilibrium within the individual.
Nursing is concerned with the organized and integrated whole, but that the
major focus is on maintaining a balance in the behavior system when illness
occurs in an individual.
 Betty Neuman
Neuman System Model

• Is a nursing theory based on the individual's relationship to

stress, the reaction to it, and reconstitution factors that are
dynamic in nature.
the concept of a whole person and an open system approach.

The concept is aimed towards the development of a person in a

state of wellness having the capacity to function optimally by
adaptation with environmental stimuli causing illnesses back to a
state of wellness
Major Concepts
• Nursing - requires a holistic approach that considers all factors
affecting a client's health—physical, physiological,
psychological, mental, social, cultural, developmental and
spiritual well-being.
• Person - as an individual family community or the society.
• Health - as dynamic in nature in which the person’s health is as
the level of health continuum—wellness or illness.
• Environment - can be an internal and external.
Stressors are the forces created by the environment. Stressors
are tensions that produce alterations in the normal flow of the
environment. These stressors can be:
1. Intrapersonal - occurs within the self and comprises of man
as a psycho-spiritual being
2. Interpersonal - occurs between one or more individual and
consists of man as a social being
3. Extrapersonal - occurs outside the individual and may include
environmental factors
 System Model in Nursing Practice
1. Client variables
- Physiological, sociocultural developmental and spiritual—function to achieve stability in
relation to the environmental stressors experienced by the client.
2. Lines of resistance
- acts when the normal line of defense is invaded by too much stressor causing alteration in
the normal health pattern to facilitate coping and overcome the stressors that are present
within the individual.
3. Normal line of defense
- acts in coordination with the normal wellness state. It is the normal reaction of the client in
response to stress – the baseline determinants of wellness within the health continuum.
- 4. Flexible line of defense
- helps the body to adjust to situations that threaten the imbalance within the client's
stability.
5. Stressors
stressors are forces that produce tensions, alterations or potential
problems causing instability within the clients system.
6. Reaction
reactions are the outcomes or produced results of certain stressors and
actions of the lines resistance of a client. It can be positive or negative
depending on the degree of reaction the client produces to adjust and
adapt with the situation.
A. Negentropy is set towards stability or wellness
b. Egentropy is set towards disorganization of the system producing illness
7. Prevention
prevention is used to attain balance within the continuum of health
8. Reconstitution
A state of returning back to old health self.
 Three Levels of Prevention
• A. Primary prevention – focuses on foreseeing the result of an act or situation
and preventing its unnecessary effects as possible. It also aims to strengthen
the capacity of a person to maintain an optimum level of functioning while
being interactive with the environment. Ex. Health promotion and disease
prevention. 
B. Secondary prevention – focuses on helping alleviate the actual existing
effects of an action that altered the balance of health. It aims to reduce
environmental influences that cause an alteration in the stability of the client.
Ex. Early diseases detection and prompt treatment. 
C. Tertiary prevention – focuses on the actual treatments or adjustments to
facilitate strengthening of person after being exposed to stressor. Aims to
prevent regression and recurrence of the disease. Ex. Rehabilitation