Republic of the Philippines

UNIVERSITY OF EASTERN PHILIPPINES

University Town, Northern Samar
Web: http://uep.edu.ph Email: uepnsofficial@gmail.com

COLLEGE OF NURSING AND ALLIED HEALTH SCIENCES

BS NURSING

THEORETICAL FOUNDATION IN NURSING

LESSON 3

Prepared by:

NEMIA G. FLORANO, RN, MAN, PhD

Professor

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 LESSON 3.
NURSING THEORETICAL WORKS

O VERVIEW
Introduction
Welcome to Lesson 3.

You’ve learned from the previous lessons the history

and the definition of nursing theory, its significance in nursing,
purpose in generating knowledge-base for nursing, and the
classification of nursing theories according to Raile Alligood
(2007), in her book, Nursing Theorists and Their Work,
categorized nursing theories into four headings: nursing
philosophy, nursing conceptual models, nursing theories and
grand theories, and middle-range nursing theories. This lesson
will give you a summary of the various published nursing
theoretical works under the first category.
Let’s deep dive into learning about the nursing
philosophies by reading the provided comprehensive review of
their work.

Figure 1. Welcome to Theoretical Foundation in Nursing

Module – Lesson 3

LEARNING OUTCOMES:
1. Discuss relevant concepts of collaboration with interpersonal, cultural and related
theories.

LEARNING OBJECTIVES
1. Appreciate nursing theorists who are noted for their development of nursing theory.
2. Learn to understand and interpret the theoretical works of the theorists, each represent an
important contribution to the development of specialized nursing knowledge.
3. Integrate relevant concepts and metaparadigm of nursing philosophies in nursing practice
4. Describe the first type of nursing theoretical works as categorized by Alligood.
5. Discuss the role of nursing philosophies in knowledge development in the evolution of
the discipline in nursing, nursing science, and advance nursing practice.

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KEY TERMS:
Caring: the work or practice of looking after those unable to care for themselves,
especially sick and elderly people.
Nursing Philosophy: sets forth the meaning of nursing phenomena through analysis,
reasoning, and logical reasoning.

ACTIVITY
Do this activity before reading the abstraction:

1. Write an autobiography, include your personal experiences and relationship with your
family, friends and others. You don’t have to be famous to write your life story.
Begin by brainstorming.

ANALYSIS
Now that you have written your autobiography, did you find it difficult? Did you
brainstormed before writing? What have you realized? Did you compiled life experiences
that you thought worth writing? Challenge yourself by always keeping on doing each
activity correctly that will help you understand and appreciate every lesson.

ABSTRACTION

Lesson 3:
Nursing Philosophies

I.
NIGHTINGALE’S
ENVIRONMENTAL THEORY

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 Nightingale's
Environmental Theory
Florence Nightingale, considered the founder of
educated and scientific nursing and widely known
as "The Lady with the Lamp", wrote the first
nursing notes that became the basis of nursing
practice and research. The notes, entitled Notes
on Nursing: What it is, What is not, listed some of
her theories that have served as foundations of
nursing practice in various settings including the
succeeding conceptual frameworks and theories in
the field of nursing. Nightingale is considered the
first nursing theorist. One of her theories was the
Environmental Theory, which incorporated the
restoration of the usual health status of the nurse's
clients into the delivery of health care—it is still
practiced today.

The Basics:
• Florence Nightingale (12 May 1920 – 13 August 1910) was a nurse who contributed
in developing and shaping the modern nursing practice and has set examples for
nurses which are standards for today’s profession.
• She is the first nurse theorist well-known for developing the Environmental Theory
that revolutionized nursing practices to create sanitary conditions to patients to get
care.
• She is recognized as the Founder of Modern Nursing.
• Defined Nursing as “the act of utilizing the environment of the patient to assist him in
his recovery.”
• Focuses on the patient and his environment.
• Notes on Nursing: “What It Is, What It Is Not.”
• She focused on changing and manipulating the environment in order to put the
patient in the best possible conditions for nature to act.
• Stated the nursing “ought to signify proper use of fresh air, light, warmth, cleanliness,
quiet, and proper selection and administration of diet - all at the least expense of vital
power to the patient.
• She believed that in the nurturing environment, the body could repair itself.
• Client’s environment is manipulated to include appropriate noise, nutrition, hygiene,
socialization and hope.
• Identified five (5) environmental factors: fresh air, pure water, efficient drainage,
cleanliness or sanitation, and light and direct sunlight.

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• Florence Nightingale also believed that nurses could encourage or discourage the
healing process based on their interactions with a patient. She believed that nurses
who attempted to falsely cheer up a patient were not creating an appropriate
environment.
• The major concepts of Florence Nightingale’s Theory are: Nursing “What nursing
has to do… is to put the patient in the best condition for nature to act upon him”
(Nightingale, 1859/1992)

II.
WATSON’S THEORY OF HUMAN
CARING

The Basics:
 She pioneered the Philosophy and Theory of Transpersonal
Caring/Human Caring.
 “Nursing is concerned with promoting health, preventing
illness, caring for the sick, and restoring health.
 Mainly concerns on how nurses care for their patients, and how
that caring progresses into better plans to promote health and
wellness, prevent illness and restore health.
 Focuses on health promotion, as well as the treatment of
diseases.
 Caring is central to nursing practice and promotes health better
than a simple medical cure.

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  The philosophy of caring and science examines the relatedness
of everything, including: human science, human caring
processes, experiences, phenomena
 Watson’s Caring Science and Human Caring Theory blends the
sciences and humanities
 Watson likes to site Eastern Philosophy and the Foundations of
Buddhism: focus on holism

Reflect on this:

Watson’s Current Works

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Watson’s Theory of Human Caring Model

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Figure: Jean Watson Quotes

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 III. PATRICIA BENNER’S STAGES
OF NURSING EXPERTISE

 The five stages of proficiency in the novice to expert model are: novice,
advanced beginner, competent, proficient, and expert (Benner, 1982).
 The model posits that changes in four aspects of performance occur in movement
through the levels of skill acquisition.
 As the novice gains knowledge, the individual progresses to the advanced
beginner stage.

Benner’s model of from Novice to Expert is situational and describes five (5)
levels of skill acquisition and development.

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 Benner (1984a) adapted the Dreyfus model of skill acquisition to clinical
nursing practice.

IV.
ERIKSSON’S CARITATIVE
CARING THEORY
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 Katie Eriksson

“Caritative caring means that we take

“caritas” into use when caring for the
human being in health and suffering

…. Caritative caring is a
manifestation of the love that ‘just
exists’…Caring communion, true
caring, occurs when the one caring in
a spirit of caritas alleviates the
suffering of the patient”
(Eriksson, 1992c, pp. 204, 207).

1943 to Present

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.

The key ideas of Eriksson's theory of caritative caring are linked to the
metaparadigm concepts of human being, health and suffering, caring and
environment. All of these are permeated with the ethos of caritative caring, that
is, the caritas thought of human love and mercy, and the honouring of the absolute
dignity of human beings.

https://nursing-theory.org/nursing-theorists/Katie-Eriksson.php
The Theory of Caritative Caring was developed by Katie Eriksson. This model of
nursing distinguishes between caring ethics, the practical relationship between the patient
and the nurse, and nursing ethics. Nursing ethics are the ethical principles that guide a
nurse’s decision-making abilities

MAJOR CONCEPTS & DEFINITIONS

Caritas
Caritas means love and charity. In caritas, eros and agapé 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. It means that caring is an endeavor to mediate faith, hope, and
love through tending, playing, and learning.

Caring communion
Caring communion constitutes the context of the meaning of caring and is the structure that determines caring reality. Caring gets its distinctive
character through caring communion (Eriksson, 1990). It is a form of intimate connection that characterizes caring. Caring communion requires
meeting in time and space, an absolute, lasting presence (Eriksson, 1992c). Caring communion is characterized by intensity and vitality, and by
warmth, closeness, rest, respect, honesty, and tolerance. It cannot be taken for granted but pre-supposes a conscious effort to be with the other.
Caring communion is seen as the source of strength and meaning in caring. Eriksson (1990) writes in Pro Caritate, referring to Lévinas:

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 Entering into communion implies creating opportunities for the other—to be able to step out of the enclosure of his/her own
identity, out of that which belongs to one towards that which does not belong to one and is nevertheless one’s own—it is one
of the deepest forms of communion (pp. 28–29).
Joining in a communion means creating possibilities for the other. Lévinas suggests that considering someone as one’s own son implies a
relationship “beyond the possible” (1985, p. 71; 1988). In this relationship, the individual perceives the other person’s possibilities as if they were
his or her own. This requires the ability to move toward that which is no longer one’s own but which belongs to oneself. It is one of the deepest
forms of communion (Eriksson, 1992b). Caring communion is what unites and ties together and gives caring its significance (Eriksson, 1992a).

The act of caring

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

Caritative caring ethics comprises the ethics of caring, the core of which is determined by the caritas motive. Eriksson makes a distinction
between caring ethics and nursing ethics. She also defines the foundations of ethics in care and its essential substance. 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. It is about the approach we
have toward the patient. Nursing ethics deals with the ethical principles and rules that guide my work or my decisions. Caring ethics is the core of
nursing ethics. The foundations of caritative ethics can be found not only in history, but also in the dividing line between theological and human
ethics in general. Eriksson has been influenced by Nygren’s (1966) human ethics and Lévinas’ (1988) “face ethics,” among others. Ethical caring
is what we actually make explicit through our approach and the things we do for the patient in practice. An approach that is based on ethics in
care means that we, without prejudice, see the human being with respect, and that we confirm his or her absolute dignity. It also means that we
are willing to sacrifice something of ourselves. The ethical categories that emerge as basic in caritative caring ethics are human dignity, the caring
communion, invitation, responsibility, good and evil, and virtue and obligation. In an ethical act, the good is brought out through ethical actions
(Eriksson, 1995, 2003).

Dignity
Dignity constitutes one of the basic concepts of caritative caring ethics. Human dignity is partly absolute dignity, partly relative dignity. Absolute
dignity is granted the human being through creation, while relative dignity is influenced and formed through culture and external contexts. A
human being’s absolute dignity involves the right to be confirmed as a unique human being (Eriksson, 1988, 1995, 1997a).

Invitation
Invitation refers to the act that occurs when the carer welcomes the patient to the caring communion. The concept of invitation finds room for a
place where the human being is allowed to rest, a place that breathes genuine hospitality, and where the patient’s appeal for charity meets with a
response (Eriksson, 1995; Eriksson & Lindström, 2000).

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 dying away from something, and through reconciliation, the wholeness of body, soul, and spirit is re-created, when the human being’s
holiness and dignity appear. Suffering is a unique, isolated total experience and is not synonymous with pain (Eriksson, 1984, 1993).

Suffering related to illness, to care, and to life

These are three different forms of suffering. Suffering related to illness is experienced in connection with illness and treatment. When the patient
is exposed to suffering caused by care or absence of caring, the patient experiences suffering related to care, which is always a violation of the
patient’s dignity. Not to be taken seriously, not to be welcome, being blamed, and being subjected to the exercise of power are various forms of
suffering related to care. In the situation of being a patient, the entire life of a human being may be experienced as suffering related to life
(Eriksson, 1993, 1994a; Lindholm & Eriksson, 1993).

The suffering human being

The suffering human being is the concept that Eriksson uses to describe the patient. The patient refers to the concept of patiens (Latin), which
means “suffering.” The patient is a suffering human being, or a human being who suffers and patiently endures (Eriksson, 1994a; Eriksson &
Herberts, 1992).

Reconciliation
Reconciliation refers to the drama of suffering. A human being who suffers wants to be confirmed in his or her suffering and be given time and
space to suffer and reach reconciliation. Reconciliation implies a change through which a new wholeness is formed of the life the human being
has lost in suffering. In reconciliation, the importance of sacrifice emerges (Eriksson, 1994a). Having achieved reconciliation implies living with
an imperfection with regard to oneself and others but seeing a way forward and a meaning in one’s suffering. Reconciliation is a prerequisite of
caritas (Eriksson, 1990).

Caring culture
Caring culture is the concept that Eriksson (1987a) uses instead of environment. It characterizes the total caring reality and is based on cultural
elements such as traditions, rituals, and basic values. Caring culture transmits an inner order of value preferences or ethos, and the different
constructions of culture have their basis in the changes of value that ethos undergoes. If communion arises based on the ethos, the culture
becomes inviting. Respect for the human being, his or her dignity and holiness, forms the goal of communion and participation in a caring
culture. The origin of the concept of culture is to be found in such dimensions as reverence, tending, cultivating, and caring; these dimensions are
central to the basic motive of preserving and developing a caring culture (Eriksson, 1987a; Eriksson & Lindström, 2003).

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APPLICATION AND EXERCISE:
Post-test

Part I. Mastery

1. What is the major concepts of Florence Nightingale’s theory?

2. Explain in your own words the meaning of Jean Watson Quotes relating it to the
theory of human caring.

3. What is the ultimate goal of caring in Caritative Caring theory? Please relate and
explain.

FEEDBACK
How did you find the lesson? Were you able to comprehend what was presented, answered the
activity/post-test and met the set learning objectives? Did you learn about the theoretical works
categorized as nursing philosophies comprehensively reviewed, summarized and provided in this section?
If the answer is yes, nice one, you are now ready for the second type, the nursing conceptual models,
which is our next lesson. But if you find some difficulty, review and analyze the lesson very carefully
until you fully understand the content.

SUMMARY
This lesson presents an overview, and summary of the various published nursing theoretical
works under the first category, the nursing philosophies: Florence Nightingale, Jean Watson, Patricia
Benner and Katie Eriksson theories, was comprehensively provided with models, reviewed and
summarized for easy comprehension.

REFERENCES

1. Alligood, M. R. (2014). Nursing theorist and their work. 8th edition. Elsevier.

2. George, J. (2012). Nursing Theories: The base for Professional Nursing Practice. 6th
edition.
3. Tomey, A. M., & Alligood, M. R. (2006). Nursing theorists and their work. 6th
Edition. St. Louis: Mosby

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