Florence Nightingale (Nightingale’s Environmental Theory)

➢ Born on May 12, 1820 in Florence, Italy

➢ Died on August 13, 1910 Mayfair, London
➢ William Edward- father, Frances Nightingale- mother, and Frances Parthenope Verney- sibling
➢ Enrolled as a nursing student in 1850 at the Institution of Protestant Deaconesses in Kaiserwerth, Germany
➢ Established a school for nursing at St. Thomas hospital in London, in 1860.
➢ Completed her nursing training in 1851 (age 31) at Kaiser Werth, Germany; a protestant religious community with
a hospital facility
➢ Took a nursing job in a Harley Street hospital for ailing governesses
➢ Nightingale also volunteered at the Middlesex Hospital around 1850’s, grappling with a cholera outbreak and
unsanitary conditions conducive to the rapid spread of the disease
➢ Her father and others tutored her in mathematics, languages, religion, and philosophy (influences on her lifework).

Theoretical Sources

➢ The Nightingale family’s social status provided her with easy access to people of power and influence.
➢ She recognized the societal changes of her time and their impact on the health status of individuals.
➢ Her alliance with Dickens undoubtedly influences her definitions of nursing and health care and her nursing
philosophy.
➢ Nightingale’s religious affiliation and beliefs were especially strong sources for her nursing philosophy.
➢ Her faith provided her with personal strength throughout her life and with the belief that education was a critical
factor in establishing the profession of nursing.

Major Assumption

➢ Nursing- Nightingale believed that 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
➢ Person- Nightingale referred to the person as a patient. Nurses performed tasks to and for the patient and
controlled the patient’s environment to enhance recovery.
➢ Health- Nightingale defined health as being well and using every power (resource) to the fullest extent in living
life. She defined disease and illness as a reparative process the nature instituted when a person did not attend to
health concerns.
➢ Environment- Nightingale’s concept of environment emphasized that nursing was to assist nature in healing the
patient. Little, if anything, in the patient’s world is excluded from her definition of environment

Assumptions of Florence Nightingale’s Theory

➢ Florence Nightingale believed that five points were essential in achieving a healthful house: “pure air, pure water,
efficient drainage, cleanliness, and light.”
➢ A healthy environment is essential for healing. She stated that “nature alone cures.”
➢ Nurses must make accurate observations of their patients and report the state of the patient to the physician in
an orderly manner.
➢ Nursing is an art, whereas medicine is a science. Nurses are to be loyal to the medical plan but not servile.

Logical Form

➢ Nightingale used inductive reasoning to extract laws of health, disease, and nursing from her observations and
experiences. Her childhood education, particularly in philosophy and mathematics, may have contributed to her
logical thinking and inductive reasoning abilities.
Acceptance by Nursing Community

➢ Practice- Nightingale’s nursing principles remain the foundation of nursing practice. The environmental aspects of
her philosophy (i.e., Ventilation, Warmth, Quiet, Diet, and Cleanliness) remain integral components of nursing
care.
➢ Education- Nightingale’s principles of nurse training (instruction in scientific principles and practical experience
for the mastery of skills.) provided a universal template for early nurse training schools beginning with St.
Thomas’s Hospital and King’s College Hospital in London.
➢ Research- Nightingale’s interest in scientific inquiry and statistics continues to define the scientific inquiry used in
nursing research. She was exceptionally efficient and resourceful in her ability to gather and analyze data her
ability to represent data graphically was identified in the polar diagrams.

Critique

➢ Clarity- Nightingale believed that the environment was the main factor that created illness in a patient.
-> Nightingale discussed the concept of observation extensively.
-> The nurse must use her brain, heart, and hands to create healing environments.

3 major concepts

➢ Environment to patient
➢ Nurse to environment
➢ Nurse to patient

➢ Simplicity-Provides a descriptive, explanatory theory.

-> Tested the theory in an informal manner by collecting data and verifying improvements.

-> Provides general rules and explanations that would result in good nursing care for patients.

➢ Generality- provides general guidelines for all nurses.

-> nurses are increasingly recognizing the role of observation.

-> the relation concept (nurse, patient, and environment) remain applicable in all nursing settings today.

-> nightingale provided a basis for providing holistic care to the patients.

➢ Accessibility- presented as truths rather than as tentative, testable statements.

- > the nurse’s practice should be based on their observation and experiences.

➢ Importance- direct the nurse to act on behalf of the patient.

-> the nurses should be specifically educated and trained for their positions in health care.

-> improve the standards of nursing profession, also enhanced the hospitals in which they worked.

Jean Watson: Watson’s Philosophy and Theory of Transpersonal Caring

Credentials and Background of the Theorist
Margaret Jean Harman Watson, PhD, RN, AHN-BC, FAAN
-born and grew up in the small town of Welch, West Virginia.
-the youngest of eight children
-Attended high school in West Virginia and Lewis Gale School of Nursing in Roanoke, Virginia
- married Douglas Watson after her graduation in 1961
-Watson continued her nursing education at the University of Colorado
-she earned baccalaureate degree in nursing in 1964. a master’s in 1966, and doctorate in educational psychology and
counseling in 1973.
-joined the School of Nursing faculty at the University of Colorado Health Sciences Center
-in 1981 and 1982, she pursued international sabbatical studies in New Zealand, Australia, India, Thailand, and Taiwan
-in 2005, she took a sabbatical for a walking pilgrimage in the Spanish El Camino
-in 1980s, Watson and colleagues establish the Center for Human Caring at the University of Colorado, the nation’s first
interdisciplinary center using human caring knowledge for clinical practice, scholarship, administration and leadership.
-Watson Caring Science Institute (WCSI) was established by Watson from groundwork laid by the Center for Human Caring
->WSCI is a non-profit organization devoted to advancing caring science in Global World Caring Science
programs and projects.
->WSCI has defined to focus in four distinct parts: education, praxis, research, and legacy.

Theoretical Sources
-Watson’s work has been called a philosophy, blueprint, ethic, paradigm, worldview, treatise, conceptual model, and
theory.
-defines theory as “an imaginative grouping of knowledge, ideas, and experience that are represented symbolically and
seek to illuminate a given phenomenon”
-draws the Latin meaning of theory “to see”
-shared humanity is the basis of an ethical and moral relationship, the basis for Caritas-Veritas and nurse praxis
-Watson describes Veritas as needed to “convey nursing’s morality and value commitment to timeless, enduring values
that intersect with Caritas, which unites caring and love”
-Watson describes a “transpersonal caring relationship” as foundation to her theory; it is a “special kind of human care
relationship--a union with another person-- high regard for the whole person and their being-in-the-world”

Watson’s Carative Factors

The original carative factors served as a guide to what was referred to as the "core of nursing", in contrast to nursing’s
"trim". Core pointed to those aspects of nursing that potentiate therapeutic healing processes and relationships; they
affect the one caring and the one-being-cared-for.

10 Carative Factors

1. Formation of a humanistic-altruistic system of values

-Begins at an early age with values shared with the parents,
-Own life experiences, learning one gain and exposure to humankind.
-Necessary to the nurse’s own maturation promotes altruistic behavior towards others
2. Instillation of faith-hope
-When modern science has nothing further to offer the person, the nurse can continue to use faith-hope to
provide a sense of well-being through beliefs which are meaningful to the individual.
3. Cultivation of sensitivity to one’s self and to others
-Development of one’s own feeling is needed to interact genuinely and sensitively with others.
4. Development of helping-trust, human caring relationship
-Strongest tool is the mode of communication, which establishes rapport and caring
-Characteristics are Congruence, Empathy and Warmth
-Communication includes verbal, non-verbal and listening which connotes empathetic understanding
5. Promotion and acceptance of the expression of positive and negative feelings
-Feelings alter thoughts and behavior, and they need to be considered and allowed for in a caring relationship
-Increases one’s level of awareness
-Awareness of the feelings helps to understand the behavior it causes
6. Systematic use of a creative problem-solving caring process
-Allows for control and prediction, and permits self-correction.
 7. Promotion of transpersonal teaching-learning
-The caring nurse must focus on the learning process as much as the teaching processes
-Understanding the person’s perception of the situation assists the nurse to prepare a cognitive plan
8. Provision for a supportive, protective, and or corrective mental, physical, societal, and spiritual environment
-The nurse manipulates the external and internal variables to provide support and protection for the person’s
mental and physical well-being
-External and Internal environment are interdependent
9. Assistant with gratification of human needs
-Watson created a hierarchy of need similar to that of Maslow’s
-Each need is equally important for quality nursing care
-All needs deserve to be attended to and valued
10. Allowance for existential-phenomenological spiritual forces
-The nurse assists the person to find strength or courage to confront life or death

Watson’s Ordering of needs

1. Lower order needs (Biophysical needs)

-The need for food and fluid
-The need for elimination
-The need for ventilation
2. Lower order needs (Psychophysical needs)
-The need for activity and inactivity
-The need for sexuality
3. Higher order needs (Psychosocial needs)
-The need for achievement
-The need for affiliation
4. Higher order need (intrapersonal-interpersonal need)
-The need for self-actualization

Caritas Processes
"Caritas" comes from the Greek word meaning to cherish, to appreciate, to give special attention, if not loving, attention
to; it connotes something that is very fine, that indeed is precious.
“At this time, I now make new connections between carative, caritas and without hesitation invoke the "L" word, which
caritas conveys, that is love, allowing love and caring coming together for a new form of deep transpersonal caring.”
(Watson, 1998)

Use of Empirical Evidence

-Watson research into caring incorporates empiricism but emphasizes approaches that begin with nursing phenomena
rather than with natural science.
-she increasingly incorporated her conviction that a sacred relationship exists between humankind and the universe

Major Assumption
-Watson joins science with humanities, giving nurses a strong liberal arts background to understand other cultures for
using caring science and a mind-body-spiritual framework

Theoretical Assertion
Nursing
-Nursing consist of “knowledge, thought, values, philosophy, commitment, action, with some degree of passion”
-Watson’s theory calls nurses to go beyond procedures, tasks, and techniques in practice, the trim of nursing, in contrast
to the core of nursing, those aspects of the nurse-patient relationship resulting therapeutic outcome included in the
transpersonal caring process
-Watson described curing as a medical term that refers to the elimination of disease
Person
-Watson uses interchangeably the terms human being, person, life, personhood, and self
-She views the person as “a unity of mind/spirit/nature”
Health
-Watson’s definition of health was originally derived from the World Health Organization as “the positive state of
physical, mental, and social well-being”
-later she defined health as “unity and harmony within the mind, body, and soul”
Environment
-Watson spoke to the nurse’s role in the environment as “attending to supportive, protective, and/or corrective
mental, physical, societal, and spiritual environments” in the original carative factors
-in later work, a broader view of environment states “the caring science is not only for sustaining humanity but also for
sustaining the planet… Belonging is to an infinite universal spirit world of nature and all living things; across time and
space, boundaries, and nationalities”

Logical Form
-Watson’s definition of caring as opposed to curing is to delineate nursing from medicine and classify the body of
knowledge as a separate science.

Application by the Nursing Community

Practice
-Watson’s theory has been validated in outpatient, inpatient, and community health settings
-Attending Nursing Caring Model (ANCM) exemplified the application of Watson Caring Science to practice, initially
described in Watson and Foster as an application of theory to practice.
->unlike a medical cure model, the ANCM is concerned with the nursing care
Administration and Leadership
-Watson’s theory calls for administrative practices and business models to embrace caring, even in a health care
environment of increased acuity levels of hospitalized individuals, short hospital stays, increasing complexity of
technology,
and rising expectations in the “task” of nursing.
Education
-Watson’s writing focus on educating graduate nursing students and providing them with ontological, ethical, and
epistemological bases for their practices, along with research directions.
Research
-Qualitative, naturalistic, and phenomenological methods have been identified as particularly relevant to the study of
caring and to the development of nursing as a human science

Benner’s Stages of Nursing expertise, Nursing philosophies

Patricia Benner

➢ Born on May 10, 1955 in Hampton, Virginia, to parents Shirley and Clint Sawyer.
➢ She Married Richard Benner in August 1967 and had 2 children: a son born in 1973 and a daughter born in 1981.
➢ First became interested in Nursing when she had the opportunity to work as an admitting clerk at a Hospital at
Pasadena, California.
➢ She receives her Bachelor’s Degree in Nursing in Pasadena City College 1964.
➢ She obtained her Master’s Degree from the University of California, Berkeley, in Medical-Surgical Nursing.
➢ Upon completion of Doctorate in 1982, she became an Associate professor at the University of California, San
Francisco, in the Department of Psychological Nursing.
➢ Dr. Patricia Benner is a Nursing theorist who first developed a model for the stages of clinical competence in her
classic book” From Novice to Expert: Excellence and Power in Clinical Nursing Practice”. Her model is one of the
most useful frameworks for assessing nurse’s needs at different stages of professional growth.
 Expert
Proficient

Competent

Advanced Beginner

Novice

Benner’s Stages

✘ Novice (Nursing Students)

• No Experience
• Task\Skills Focused
• Rule Follower
• Inflexible
✘ Advanced Beginner (Newly graduate nurse)

• Has some Experience

• Past Experience guides actions
✘ Competent (Start nurse to head nurse)

• 2-3 years’ Experience

• Good time Management
• Planning
• Thinks analytically
✘ Proficient (Supervisor)

• Holistic Understanding
• Uses Experiences to anticipate needs
✘ Expert (Chief nurse)

• Flexible
• Intuition\Intuitive
• Lots of Experience
• Just comes naturally

Major Assumption

➢ There are no interpretations-free data.

➢ It abandons the assumption from natural science that there is an independent reality.
➢ Can be represented by abstract terms and concepts.
➢ There are no nonreactive data.
➢ It abandons the false beliefs from natural science that one can neutrally observe brute data.
➢ Embedded in SKILLS, PRACTICES, INTENTIONS, EXPECTATIONS, and OUTCOMES.
Nursing

➢ As a caring relationship, “Enabling condition and connection and concern”

➢ Understand the nursing practice as the care and experience of health, illness, and disease.

Person

➢ It is a self-interpreting being, that the person does not come into the world predefined but gets defined in the
course of living a life.

Four major aspects of understanding that the person must deal with:

1. The role of the situation.

2. The role of the body.
3. The role of personal concerns.
4. The role of temporarily.

Health

➢ Defined as what can be assessed, whereas well-being is the human experience of health and wellness.
➢ Described as not just the absence of disease and illness.

Situation/Environment

➢ Conveys a social environment with social definition and meaningfulness.

➢ The phenomenological terms being situated and situated meaning.

Logical Form

➢ Through Qualitative Descriptive research, Benner used the Dreyfus Model of Skill Acquisition to better understand
skill acquisition in clinical nursing practice
➢ Benner was able to identify the performance characteristics and teaching-learning needs inherent at each skill
level.
➢ The goal of Benner’s research is to bring meanings and knowledge embedded in skilled practice into public
discourse.
➢ Benner claims that new knowledge and understanding are constituted by articulating meanings, skills, and
knowledge that previously were taken for granted and embedded in clinical practice.

Acceptance by the Nursing Community

Practice

➢ Benner describes clinical nursing practice by using an interpretive phenomenological approach.

➢ Many people or well-known Nurses has cited Benner in Nursing literature regarding Nursing practice concerns
and the role of caring in such Practice
➢ Benner’s work with the National council of State Boards of Nursing constitutes a major contribution to error
recognition and enhancement.

Education

➢ Emphasized the importance of learning the skills of involvement and caring through practical experiences, the
articulation of knowledge with practice
➢ The use of narratives in undergraduate education.
 ➢ Provides further support for the thesis that it may be better to place a new graduate with a competent nurse
preceptor.

Research

➢ Her Theory presents the interpretive phenomenology, philosophy, and research approach that continues to
evolve.
➢ Benner’s numerous researches has created a community of interpretative phenomenological scholars.

Critique

Clarity

➢ The clarity of Benner’s Novice to Expert model has led to its utilization among nurses around the world.
➢ Benner’s work not only contributed to appreciative understanding of clinical practice but also revealed nursing
knowledge embedded in practice.

Simplicity

➢ Benner has developed interpretive descriptive accounts of clinical nursing practice.

➢ The concepts are the levels of skilled practice from the Dreyfus model.

Generality

➢ The Novice to Expert skill acquisition model has universal characteristics, that is, it is not restricted bye age, illness,
health or location of Nursing practice.

Accessibility

➢ This approach to knowledge development honors the primacy of caring and the central ethic of care and
responsibility.
➢ Benner’s work can be considered as Hypothesis generating rather than Hypothesis Testing.

Importance

➢ This Theory is a great significance to the nursing profession, because it offers useful information to new nurses,
as well as experienced Nurses.
➢ It is also important because the model allows for skill acquisition and knowledge to be gained as an individual
progress through each stage.

KATIE ERIKSSON: THEORY OF CARITATIVE CARING

➢ She is a 1965 graduate of the Helsinki Swedish School of Nursing, and in 1967, she completed her public health
nursing specialty education at the same institution.
➢ After taking nursing in 1965 to be able to practice nursing, she became a nursing instructor at Helsinki Swedish
Medical Institute.
➢ She currently works as a professor of health sciences at Abo Akademi University in Vaasa, where she built a
master’s degree program in health sciences, and a four-year postgraduate studies program leading to a doctoral
degree in health sciences.
➢ Eriksson was born on November 18, 1943, in Jacob’s City, Finland.
➢ She belongs to the Finland Swedish minority in Finland, and her native language is Swedish.
➢ Professor Katie Eriksson passed away on the 30th of August 2019 at the age of 75
THEORY OF 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 the 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 SOURCES OF THEORY

➢ Eriksson’s leading thoughts have been not only to develop the substance of caring, but also to develop caring
science as an independent discipline.

➢ Eriksson wanted to go back to the great Greek classics by Plato, Socrates, and Aristotle, from whom she found
her inspiration for the development of both the substance and the discipline of caring science.

Major concepts and definition

CARITAS

➢ motive for all caring. 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.

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 major concepts and
definitions meeting in time and space, an absolute, lasting presence.

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.

CARITATIVE CARING ETHICS

➢ 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 and the nurse-the way in which the nurse meets
the patient in an ethical sense.

DIGNITY

➢ Dignity constitutes one of the basic concepts of caritative caring ethics. Human dignity is party absolute dignity,
partly relative dignity.

INVITATION

➢ Invitation refers to the act that occurs when the carer welcomes the patient to the caring communication.

SUFFERING

➢ Suffering is an ontological concept describe as a human being’s struggle between good and evil in a state of
becoming. Suffering implies in some sense dying.

➢ The suffering human being is the concept that uses to describe the patient.
 ➢ The patient is a suffering human being, or a human being who suffers and patiently endures.

RECONCILIATION

➢ Reconciliation refers to the drama of suffering.

➢ Reconciliation 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 uses instead environment. It characterizes the total caring reality and is based on
cultural elements such as traditions, rituals, and basic values

MAJOR ASSSUMPTIONS

➢ Eriksson distinguishes two kinds of major assumptions: AXIOMS and THESES

➢ She regards AXIOMS as fundamental truths in relation to the conception of the world;
➢ THESES are fundamental statements concerning the general nature of caring science, and their validity is tested
through basic research.
➢ Axioms and Theses jointly constitute the ontology of caring science and therefore also are the foundation of its
epistemology.

The axioms are as follow:

➢ The human being is fundamental an entity of body, soul, and spirit.

➢ The human being is fundamental a religious being.
➢ The human being is fundamentally holy. Human of serving with love, of existing for the sake of others.
➢ Communion is the basis for all humanity. Human beings are fundamentally interrelated to an abstract and/or
concrete other in a communion.
➢ Caring is something human by nature, a call to serve in love.
➢ Suffering is an inseparable part of life. Suffering and health are each other’s prerequisites.
➢ Health is more than the absence of illness. Health implies wholeness and holiness.
➢ The human being lives in a reality that is characterized by mystery, infinity, and eternity.

The theses are as follows:

➢ Ethos confers ultimate meaning on the caring context.

➢ The basic motive of caring is the caritas motive.
➢ The basic category of caring is suffering.
➢ Caring communion forms the context of meaning of caring and derives its origin from the ethos of love,
responsibility, and sacrifice, namely, caritative ethics.
➢ Health means a movement in becoming, being, and doing while striving for wholeness and holiness, which is
compatible with endurable suffering.
➢ Caring implies alleviation of suffering in charity, love, faith, and hope. Natural basic caring is expressed through
tending, playing, and learning in a sustained caring relationship, which is asymmetrical by nature.

PERSON

➢ Person is based on the axiom that the human being is an entity of body, soul, and spirit.
➢ She emphasizes that the human being is fundamental a religious being.
➢ The human being is fundamental holy
 ➢ The human being is seen as in constant becoming: she is constantly in change and therefore never in a state
of full completion.
➢ The human being is fundamentally dependent on communication: she is dependent on other, and it is in the
relationship between a concrete other (human being) and an abstract other (some form of god)
➢ When the human being is entering the caring context, he or she becomes a patient in the original sense of
the concept suffering human being

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 originally refers to home, or to the place where a human being feels at home.
➢ Ethos and ethics belong together, and in the caring culture, they become one.

HEALTH

➢ Health as soundness, freshness, and well-being.

➢ Health implies being whole in body, soul, and spirit
➢ Health means as a pure concept wholeness and holiness.
➢ Different dimensions of health as “doing, being, and becoming with a wholeness that is unique to human
beings.

NURSING

➢ Caritas constitutes the inner force that is connected with the mission to core. A carer beams forth what
Eriksson calls claritas, or the strength and light of beauty.
➢ The fundamental 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 and 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.
➢ The core of the caring relationship, between nurse and patient is an open invitation that contains
affirmation that the other is always welcome.

LOGICAL FORM

➢ The logical form is constituted both in Eriksson’s caritative theory of caring and in caring science as a discipline.
Eriksson stresses the importance of the logical form being created on the basis of the substance of caring, not on
the basis of method. It is thus deduction combined with abduction that has formed the guiding logic.
➢ Eriksson applied three forms of inference, deduction, induction and abduction or retroduction that give the
theory a logical external structure.
➢ The caring substance is formed in a dialectical movement between the potential and the actual, the abstract
general and the concrete individual. With the help of logical abstract thinking combined with the logic of the
heart, the theory of caritative caring becomes perceptible through the art of caring.

ACCEPTANCE BY THE NURSING COMMUNITY

PRACTICE

➢ Several nursing units in the Nordic countries have based their practice and caring philosophy on Eriksson’s
ideas and her caritative theory of caring
 ➢ This include the hospital district of Helsinki and Uusimaa in Finland.
➢ In the 1970’s Eriksson’s nursing care process model was systematically used, tested, and developed as a
basis of nursing care.
➢ Eriksson’s thinking has been influential in nursing leadership and nursing administration, where the
caritative theory of nursing forms the core of the development of nursing leadership at various levels of
nursing organization.

EDUCATION

➢ Caring science not as profession but as “pure” academic discipline.

RESEARCH

1. Designed a research program based on her caring science tradition.

2. This program comprises systemic caring science, caring administration, and interdisciplinary research.
3. Her main thesis is that substance should direct the choice of research method.
4. Developing caring science for caring science has been formulated.
5. Eriksson has developed sub disciplines of caring science.
6. Eriksson has developed is caring theology
➢ Caring theology- articulated as spiritual and doctrinal questions in caring with a scientific group of themes
and has cleared the way for new thinking.
7. Caring theology has aroused great interest among caregivers in clinical practice that can be studied in
academic courses.

CRITIQUE

CLARITY

➢ Eriksson’s theory is the logical structure of the theory, in which every new concept becomes a part of a
clearly logical more comprehensive whole.
➢ Her main thesis has always been that basic conceptual clarity is needed before developing the contextual
features of the theory.
➢ Eriksson used concept analysis and analysis of ideas as central methods which led to semantic and structural
clarity.

SIMPLICITY

➢ Eriksson’s theory reflects the simplicity of the theory by showing the general in a clear and logical
conceptual entirely.
➢ Eriksson agrees with Gadamer’s thought that understanding includes application, and the theory opens the
way to deeper participation and communion.
➢ Eriksson formulates this process by the statement that “ideals reach and reality and reality reaches the
ideals”

GENERALITY

➢ Eriksson’s theory is general in the sense that it aims at creating an ontological and ethical basis of caring, and it
constitutes the core of the discipline and involves epistemology as well.
➢ Eriksson’s theory is general as a result of the wide convincing force it receives through its theoretical core
concepts and its theoretical axioms and theses.
➢ Eriksson stressed the importance of describing the core concepts on an optimal level of abstraction to include
the complex caring reality that simultaneously carries a wealth of signification that opens up understanding in
various caring contexts.
ACCESSIBILITY

➢ Eriksson’s thinking as a whole has reached an understanding that extends to other disciplines and professions.
➢ Eriksson’s theory demonstrated in multiple deductive testing manifests a combination of the clarity, simplicity,
and generality combined with a rich substance and clearly formulated ethos.

IMPORTANCE

➢ Successful for 30 years

➢ Her thinking is of importance to clinical practice, research, and education and to the development of the caring
discipline.
➢ Eriksson created her own caring science tradition, a tradition that has grown strong and set the tone for nursing
advancement and caring science.

MARTHA ROGERS: SCIENCE OF UNITARY HUMAN BEINGS

Martha Elizabeth Rogers

➢ Born: May 12, 1914, Dallas, Texas, USA

➢ Eldest of four children
➢ Father: Bruce Taylor Rogers
➢ Mother: Lucy Mulholland Keener Rogers
➢ Died: March 13,1994 at 79 years old of pulmonary failure complicated by emphysema
➢ (1931-1933) College education at university of Tennessee.
➢ (1936) Nursing diploma from Knoxville General Hospital School of Nursing.
➢ (1937) Bachelor of Science Degree from George Peabody College in Nashville, Tennessee.
➢ (1945) Master of arts degree in public health nursing supervision from Teachers College, Columbia
University, New York.
➢ (1954) Doctor of Science degree from John Hopkins University in Baltimore.
➢ (1954-1975) she was a professor and head of the Division of Nursing at New York University, at the age of
21.
➢ After 1975, she continued her duties as professor until she become Professor Emerita in 1979.
➢ (1954) Doctor of Science degree from John Hopkins University in Baltimore.
➢ (1954-1975) she was a professor and head of the Division of Nursing at New York University, at the age of
21.
➢ After 1975, she continued her duties as professor until she become Professor Emerita in 1979.

THEORETICAL SOURCES OF THEORY

Rogerian science emerged from the knowledge bases of anthropology, psychology, sociology, astronomy, religion,
philosophy, history, biology, physics, mathematics, and literature to create a model of unitary human beings and the
environment as energy fields integral to the life process.

MAJOR CONCEPTS AND DEFINITIONS

Energy fields

➢ Constitutes the fundamental unit of both the living and the non-living
➢ Energy fields are infinite and pan-dimensional
 ➢ Two fields are identified: the human field and the environmental field (Rogers, 1986).

The unitary human beings

➢ Irreducible, indivisible, pan-dimensional energy field identified by pattern and manifesting characteristics
that are specific to the whole and that cannot be predicted from knowledge of the parts.

The environment fields

➢ Define as an irreducible, pan-dimensional energy field identified by pattern and integral with the human
field.
➢ Although not necessarily quantifiable, an energy field has the inherent ability to create change (Todaro -
Franceshi, 2008)

A universe open system

➢ Holds that energy fields are infinite, open, and integral with one other (Rogers, 1983).
➢ The human and environmental fields are in continuous process and are open systems.

Pattern

➢ Pattern is defined as the distinguishing characteristics of an energy field perceived as a single wave
➢ “Pattern is an abstraction and it gives identity to the field”

Pandimensionality

➢ Pan-dimensionality is defined as “nonlinear domain without spatial or temporal attributes”

➢ The term pan dimensional provides for an infinite domain without limit. It is best express the idea of a unitary
whole.

MAJOR ASSUMPTIONS

Nursing

➢ Nursing is a learned profession and is both a science and an art. It is an empirical science, and like other
sciences, it lies in the phenomenon central to its focus.
➢ “Professional practice in nursing seeks to promote symphonic interaction between human and environmental
fields, to strengthen the integrity of the human field and to direct and redirect patterning of the human and
environmental fields for realization of maximum health potential” (Rogers, 1970, p.122).

Person

➢ Rogers defines person as an open system in continuous process with the open system that is the environment
(integrity).

Health

➢ Passive health symbolizes wellness and the absence of disease and major illness (Rogers, 1980).
➢ In Rogerian science, the phenomenon central to nursing’s conceptual system is the human life process.

Environment

➢ Rogers (1994) defines environment as “an irreducible, pandamensional energy field identified by pattern
and manifesting characteristic different from those of the parts. Each environmental field is specific to its
given human field.
THEORETICAL ASSERTIONS

Homeodynamic Principles

➢ Homeodynamic refers to the balance between the dynamic life process and environment.
➢ These principles help to view human as unitary human being.
➢ Three principles of homeodynamics.
1. Resonancy- Wave patterns are continuously changing in environmental and human energy fields.
2. Helicy- The nature of change is unpredictable, continuous and innovative.
3. Integrality- Energy fields of humans and environment are in a continuous mutual process.

LOGICAL FORM

Rogers uses a dialect method as opposed to a logistical, problematic or operational method; that is, Rogers explain
human beings. She explains human beings through principles that characterize the universe, based on the perspective of
a whole that organizes the parts.

ACCEPTANCE BY THE NURSING COMMUNITY

Practice

➢ The Rogerian models is an abstract system of ideas from which to approach the practice of nursing. Rogers’
model, stressing the totality to experience and existence, is relevance today’s health care system in which a
continuum of care is more important than episodic illness and hospitalization.

Education

➢ Roger clearly articulated guideline for the education of nurses with the SUHB (Science of Unitary Human Being).
Rogers discuss structuring nursing education programs to teach nursing as a science and as a learned profession

Research

➢ Rogers’ conceptual model provides the stimulus and direction for research and theory development in nursing
science. Fawcett (2000), who insists that the level abstraction affects direct empirical observation and testing,
endorses the designation of SUHB (Science of Unitary Human Being) as a conceptual model rather a grand
theory.

CRITIQUE

CLARITY

➢ There where early criticisms of the model with comments such as difficult-to-understand principles, lack of
operation definitions, and inadequate tools for measurement.

SIMPLICITY

➢ Ongoing studies and works within the model have serve to simplify and clarity some of the concepts and
relationships.

GENERALITY

➢ Rogers’ conceptual model is abstract and therefore generalizable and powerful. It’s broad in scope, providing of
framework for development of nursing knowledge through the generation of grand and middle range theories.
ACCESSIBILITY

➢ Drawing on knowledge from a multitude of scientific fields, Rogers’ conceptual model is deductive in logic with
an inherent lack of immediate empirical support

IMPORTANCE

➢ Rogers’ science is the fundamental intent of understanding of human evolution and it’s potential for human
betterment. The science “coordinates a universe of open system to identify the focus of a new paradigm and
initiate nursing’s identity as a science”.

Dorothea Elizabeth Orem: Self-Care Deficit Theory

➢ Born 1914 in Baltimore, US
➢ Received her diploma at Providence Hospital, Washington, DC in 1934
➢ 1939- BSN Ed. And Master of Science in Nursing education (1945) from Catholic University of America,
Washington D.C.
➢ Her clinical practice included staff nurse staff nurse in the operating room, pediatrics and adult medical surgical
units
➢ She also did private-duty nursing in private honors and the hospital and was an emergency room supervisor
➢ She taught biological sciences and later served as director of nursing service and director of the school nursing at
Providence Hospital, Michigan
➢ Received several honorary degrees
➢ Orem’s concept of nursing as the provision of self-care was first published in 1959
➢ Orem continued to develop her nursing concepts and self-care deficit theory of nursing. In 1971 she published
Nursing: Concepts of practice

Theoretical sources

➢ Orem indicates that no particular nursing leader was a direct influence in her work
➢ While crediting no one as a major influence, she does cite many other nurse’s works in terms of their
contributions to nursing; she also cites numerous authors in other disciplines

Orem’s general theory of Nursing

In related parts:

4. Theory of self-care
5. Theory of self-care deficit
6. Theory of nursing system

Theory of self-care

Based on the concepts of:

-Self-care

-Self-care agency

-Self-care requisites
-Therapeutic self-care demand

Self-care – practice of activities that an individual initiate and performs on his/her own behalf in maintaining life, health
and well-being

Self-Care Agency- is a human ability which is “the ability for engaging in self-care”; conditions by age, development state,
life experience, sociocultural orientation, health, and available resources

➢ Consist of two agents:

7. Self-care agent – person who provides the self-care
8. Dependent care agent- person other than the individual who provides the care (such as a parent)
➢ Affected by basic conditioning factors

Self-Care Requisites- reasons for which self-care is done; these express the intended or desired results

➢ Consist of three categories:

9. Universal- requisites/needs that are common to all individuals (e.g. air, water, food, elimination, rest,
activity, etc.)
10. Developmental- needs resulting from maturation of develop due to a condition or event (e.g.
adjustment to new job, puberty)
11. Health Deviation- needs resulting from illness, injury & disease or its treatment (e.g. learning to walk
with crutches after a leg fracture)

Therapeutic Self-Care Demand- the totality of “care measures” necessary at specific times or over a duration of time for
meeting an individual’s self-care requisites by using appropriate methods and related sets and actions

Theory of Self-care deficit

➢ Specifies when nursing is needed

➢ Nursing is required when an adult (or in the case of a dependent, the parent) is incapable or limited in the
provision of continuous affective self-care

Orem identifies five methods of helping

➢ Acting for and doing for others

➢ Guiding others
➢ Supporting another
➢ Providing an environment promoting personal development in relation to meet future demands
➢ Teaching another

Role of the nurse

➢ Acting (or) doing for another

➢ Guiding and directing
➢ Providing physical (or) psychological support
➢ Providing and maintaining environment that support personal development
➢ Teaching another
Theory of Nursing System

➢ Describes how the patient’s self-care needs will be met by the nurse, the patient, or both
➢ Identifies three classifications of nursing system to meet the self care requisites of the patient:
12. Wholly compensatory system- nurse should be compensating for a patient’s total inability for
(prescriptions against) engaging in self-care activities that require ambulation and manipulation
movements
13. Partly compensatory system- both nurse and patient perform care measures or other actions
involving manipulative tasks or ambulation
14. Supportive- educative system- for situations where the patient is able to perform required measures
of externally or internally oriented therapeutic self-care but cannot do so without assistance

Major assumptions

➢ People should be self-reliant and responsible for their own care and others in their family needing care
➢ People are distinct individuals
➢ Nursing is a form of action- interaction between two or more persons
➢ Successfully meeting universal and development self-care requisites is an important component of primary care
prevention and ill health
➢ A person’s knowledge of potential health problems is necessary for promoting self-care behaviors
➢ Self-care and dependent care are behaviors learned within a social-cultural context

Nursing

➢ Is art, a helping service, and a technology

➢ Actions deliberately selected an performed by nurses to help individuals or groups under their care to maintain
or change conditions in themselves or their environments
➢ Encompasses the patient’s perspective of health condition, the physician’s perspective, and the nursing
perspective

Health

➢ Health and healthy are terms used to describe living things

➢ It is when they are structurally and functionally whole or sound wholeness or integrity includes that which
makes a person human, operating in conjunction with physiological and psychological mechanisms and a
material structure and in relation to and interacting with other human beings

Environment

➢ Environment components are enthronement factors, enthronement elements, conditions, and developed
environment

Human being

➢ Has the capacity to reflect, symbolize and use symbols

➢ Conceptualized as a total being with universal, developmental needs and capable of continuous self-care
➢ A unity that can function biologically, symbolically, and socially

Nursing Client

➢ A human being who has “health-related/ health-derived limitations that render him incapable of continuous
self-care or dependent care or limitations that result in ineffective/ incomplete care
➢ A human being is the focus of nursing only when a self-care requisite exceeds self -care capabilities

Nursing problem- deficits in universal, developmental, a health derived or health relate conditions
Nursing process- a system to determine:

1. Why a person is under care

2. A plan for care
3. The implementation of care

Nursing therapeutic- deliberate, systematic and purposeful action

Logical form

➢ Deductive thinking

Acceptance by the nursing community

Practice

➢ Many articles document the use of the selfcare theory as a basis for clinical practice
➢ Orem’s self-care deficit theory has been used in the context of the nursing process to teach patients to increase
their self-care agency to evaluate nursing practice and to differentiate nursing from medical practice

Education

➢ Orem’s self-care deficit theory has been the focus of the curriculum in nursing education at many schools of
nursing

Research

➢ The self-care theory provided conceptual framework for many researches

Critique

Simplicity

➢ the conceptual framework appears simple. Sub concepts are identified to express the substantive structure of
the six broad conceptual elements of the theory

Generality

➢ the theory is expressed as universal. It is theory of nursing regardless of time or place