ORIGINAL ARTICLE
A holistic-existential approach to health promotion
Geir V. Berg1,2 RN Candidate in Nursing Science (Doctoral Student and Lecturer) and Anneli Sarvima
(Adjunct Professor and Research Director)
1
The Nordic School of Public Health, Gothenburg, Sweden, 2Gjøvik College, Faculty of Health Studies, Gjøvik, Norway, and 3Age Institute,
Helsinki, Finland
Scand J Caring Sci; 2003; 17; 384–391
A holistic-existential approach to health promotion
Health promotion seems to be implicit in many nursing
theories, but the theoretical and philosophical basis of
health promotion in nursing is not always explicitly stated.
The interpretation of health promotion is closely related to
the interpretation of man, health, illness and nursing.
There is a need to clarify, refine and redefine health pro-
motion in nursing because the concept is partly nonspecific
and has not been used to identify a distinctive nursing
focus. The aim of this study was to formulate a stipulative
definition of health promotive nursing with a holistic-
existential approach. A philosophical frame of reference in
combination with conceptual analysis and theoretical
synthesis were used as the methodological approach. The
philosophical framework served as a basis in selecting the
nursing theories and influenced the analysis. Two nursing
theories and one nursing model were selected due to their
Introduction
This article investigates how a holistic-existential approach
can be used to define health promotive nursing. Since the
1960s, the focus in nursing has been to meet patients’
needs related to maintaining health or assisting individuals
in their responses to health and illness. Health promotion
and disease prevention seems to be at least implicit in
many nursing theories (1–3). A systematic literature search
in PubMed in September 2000 and in Cinahl in May 2003
on health promotive and preventive nursing functions
gave a large number of articles addressing nursing/health
promotion or nursing/public health. Most of them seemed
to focus on groups or society at large. Health promotive
and preventive nursing based on a holistic-existential
approach, however, gave only a few hits.
Correspondence to:
Geir V. Berg, Reidar Brøggers vei 9, N-2614, Lillehammer, Norway.
E-mail: gvberg@online.no
384
2003 Nordic College of Caring Sciences, Scand J Caring Sci; 2003; 17, 384–391
€ki1,3 PhD, RN
influence on Norwegian nursing and because of their
philosophical basis. Through analysis and synthesis of the
selected nursing theories, the concepts man, health,
illness/disease and nursing were analysed. The paper
proposes a stipulative definition of health promotion in
nursing based on a holistic-existential approach, supported
by five necessary conditions. The definition and conditions
needs to be further investigated by both empirical studies
and by comparing with other relevant nursing theories, in
order to formulate theoretical statements. The proposed
definition may be the first step in a process of developing a
theoretical framework of health promotive nursing with a
holistic-existential approach.
Keywords: holistic-existential approach, health promotion,
theoretical analysis, nursing theories.
Submitted 26 July 2002, Accepted 12 August 2003
In a review article related to health promotion research
in nursing, Laffrey (4) found that the majority of studies
contributed knowledge related to three areas: health pro-
motion behaviours, instrument development and predic-
tion. Furthermore, Morgan and Marsh (5) stated:
Health-related lifestyle modification has become the
primary nursing therapy. The nursing process of
assessment and intervention is inherently a medical
model approach requiring a nurse to label a person
and intervene with universal lifestyle modification
advice, often without acknowledging the uniqueness
of the person or the meaning of his/her experience (p.
380).
According to this, preventing disease seems to be a major
focus in nursing. This emphasis focuses on patient states
and problems, i.e. a traditional biomedical view of curing,
and traditional disease prevention methods may also focus
on patient groups, types of disease or conditions in society.
Kim (6) discusses this focus, stating:
This view places an emphasis on clients’ problems that
are specified as reactions and concerns attendant with
health problems. These widely accepted orientations

have firmly grounded nursing to focus on states of
clients, rather than on clients as humans (p. 38).
/…/during the past decades, nursing has established a
firm alliance with the culture of science and tech-
nology, which is primary oriented to controlling
health problems (p. 40).
Thus, although nursing has traditionally claimed to be
holistic and humanistic and has criticized medicine to be
influenced by reductionism and viewing the human being
as a machine, one could argue that nursing also is
influenced by a biomedical approach. Furthermore, as the
literature search showed that health promotive nursing
research seemed to focus on controlling disease and
preventing health problems related to a group- or society-
level, it was evident that there is a need to address the
individual level. This need prompted the investigation of
how a holistic-existential approach could broaden the
perspective of health promotive nursing.
There is a need to clarify, reframe and redefine the
concept of health promotive nursing, because it is non-
specific and has not been used to identify a distinctive
nursing focus (4). A holistic-existential approach could
guide shifting the perspective from technical treatment and
prevention to human living. Travelbee (7), Watson (8) and
Hummelvoll (9), for example, propose and argue for such
an approach to nursing practice and science. Hummelvoll
(9) and Hedelin (10) have carried out studies specifically to
highlight the public health perspective in the context
of psychiatric nursing, applying a holistic-existential
approach. The same type of work, i.e. clarifying the nature
of health promotion from a holistic-existential viewpoint,
seems to be missing in general nursing.
The aim of this study was to formulate a stipulative
definition of health promotive nursing based on a holistic-
existential approach.
Philosophical frame of reference
In this paper, the holistic-existential perspective serves as
the overarching philosophical perspective and constitutes
the basic philosophical perspective on nursing. A holistic-
existential perspective focuses on individual’s ‘being-
in-the-world’ and on the experience and understanding of
their life (11–14). Within this perspective, nursing is based
on a multidimensional view of man and health, with focus
on people’s ‘life-world and being’ (9, 14, 15).
Within this framework, a biomedical approach is seen as
insufficient for understanding illness in relation to human
living (9). While the biomedical model focuses on disease
processes that can be identified or observed (16), the
existential model focuses on individual experiences and
the meaning of illness. The concept of illness refers to
personal experiences and reactions to symptoms or suf-
fering, while the concept of disease refers to pathological
processes seen from a medical point of view. According to

2003 Nordic College of Caring Sciences, Scand J Caring Sci; 2003; 17, 384–391
A holistic-existential approach to health promotion 385
Kim (6), Watson (8) and Hummelvoll (9), it is necessary to
supplement the biomedical model’s one-dimensional view
of man with a multidimensional view, such as the holistic
view. A holistic-existential nursing approach is concerned
with understanding the person seeking help from the
perspective of his/her actual life-situation. The purpose is
to alleviate suffering and promote self-care as well as to try
to reveal what suffering means to the person. Applied to
health promotion, this approach seeks to understand the
individual’s life-world, instead of primarily focusing on
problems and disease. According to a holistic-existential
approach, the focus of nursing is on how people experi-
ence their life related to health, illness and suffering.
The reason for formulating a philosophical framework as
the basis for this study is that the view of man, health,
illness/disease and nursing is expressed differently in
nursing theories. Barnum Stevens (17) gives an example of
how health can be viewed radically different according to
the author’s philosophical view. One theorist may hold
that health represents a continuum of states of being,
ranging from illness to wellness. Another theorist may
view health in relation to ill health. A theorist with a
holistic-existential approach is likely to argue that health is
to be a whole person, health representing a continuous
struggle for preserving identity. The opposite of health is
not disease but rather un-health or health-deficit due to
disintegration (17). These examples show that it is
important to investigate the meaning of different concepts
and their philosophical basis. In order to formulate a hol-
istic-existential approach to health promotive nursing, it is
therefore necessary to clarify these concepts as well as
investigate the underlying philosophical assumptions. As
Walker and Avant (18) claim:
Careful concept development is the basis of any
attempt to describe or explain phenomena. It is also
prerequisite to any adequate theory (p. 36).
Main concepts in the metaparadigm of nursing are man,
health and nursing (19). A definition of health promotive
nursing should thus include these concepts.
Method
The method used in this study is a theoretical analysis
inspired by the strategies outlined by Walker and Avant
(18) for theory construction in nursing. An analysis of the
concepts nursing, human being, health and illness/disease
was conducted to clarify and refine the concepts, as well as
to uncover the uses and interpretations of these concepts
in relevant nursing theories. Furthermore, a concept syn-
thesis inspired by Walker and Avant (18) was used to
propose a definition of health promotive nursing. These
two approaches resulted in a synthesis, which served as a
basis for a stipulative definition of health promotive nur-
sing based on a holistic-existential approach. The purpose
was not, at this stage, to construct a theory.
386 G.V. Berg, A. Sarvim€
aki

Walker and Avant’s (18) procedure was not strictly

followed, but their systematic and logical approach
influenced the way the study was conducted. The main
concepts were first analysed according to how the relevant
theories defined them and then according to the state-
ments. The concept analysis is a strategy that allows the
researcher to examine the attributes or characteristics of a
concept, which is useful when concepts are ambiguous or
vague. Walker and Avant (18) argued that concept analysis
was an excellent method in preparation for research or in
theory construction. In this study three steps are followed:
(i) concept analysis, (ii) comparison and (iii) synthesis. The
process can be seen as dynamic and influenced by the
philosophical frame of reference and strategies for theory
construction in nursing (17).
Two nursing theories and one nursing model were
selected from two criteria: (i) the theory should explicitly
express a holistic and/or existential approach, and (ii) the
nursing theory should be known in nursing practice and/
or education. Travelbee’s theory (7) was selected based on
both criteria. Watson’s theory (8) and Hummelvoll’s model
(9, 20) was selected based on the first criterion. Humm-
elvoll himself calls his theoretical construction a model
while Watson claims she presents a theory. However, it is
difficult to see any decisive difference between them in this
respect.
Comparison
A simple comparison between how the chosen concepts
were characterized in the selected theories was conducted.
This was done by searching for similarities or differences in
defining and describing or in statements about the con-
cepts.
Synthesis
The concepts were first analysed and then synthesized. In
synthesizing the concepts and statements, the researcher
combines isolated aspects of the concepts and statements
that are not theoretically connected. This procedure was
done within the holistic-existential frame of reference, and
resulted in a stipulative definition including five necessary
conditions.
The theoretical analysis and its results
The selected nursing theories were analysed according to
their view of man, nursing, health and illness/disease in
order to gain an understanding of the selected concepts
(cf. 19). This analysis is shown in Tables 1–4 that compare
how the concepts are defined and interpreted by the
selected theorists.

Analysis View of man

The selected nursing theories were first read in their
entirety in order to get an overview and understanding of
the authors’ philosophical basis, their definition of nursing,
view of man, health and illness/disease. Each text was read
several times, parallel to the concept and statement ana-
lysis, this according to a hermeneutical-phenomenological
tradition (9). The reading and analysis were supplemented
with search in PubMed and Cinahl as well as discussion
with students and colleagues. In this paper, concepts, and
to some extent, statements are focused upon. The concepts
that are analysed and synthesized are man, nursing, health
and illness/disease.
Travelbee (7) points out that human beings are responsible
for their choices, decisions and actions (Table 1). Human
beings are thinking organisms, capable of rational, logical
thinking while at the same time displaying irrational,
illogical, black/white dichotomized thinking. Furthermore,
an individual has the ability to know others but will never
be able to understand another human being completely.
Human beings are social and capable of relating to others.
They have the ability to know, like, love, respond to and
appreciate the uniqueness of others but also to dislike,
mistrust or even hate others. A human being strives to
transcend the self and to escape from or forget the feeling

Table 1 The concept of man

Concept Travelbee Watson Hummelvoll

View of man An unique, irreplaceable individual,
a-one-time-being in this world,
like yet unlike other person who
has ever lived or ever will live.
A biological organism affected,
influenced and changed by heredity,
environment, the culture and of all
experiences he encounters, confronts
or runs away from (p. 26)
A valued person in and of him or herself Man is a unique being and a
to be cared for, respected, nurtured, complex entity comprising body,
understood, and assisted; in general a soul and spirit in interaction
philosophical view of person fully functional with the environment
integrated self. The human is viewed as
greater than, and different from,
the sum of the parts (p. 14)

2003 Nordic College of Caring Sciences, Scand J Caring Sci; 2003; 17, 384–391
 A holistic-existential approach to health promotion 387

Table 2 The concept of nursing

Concept Travelbee Watson Hummelvoll

View of Nursing is an interpersonal process whereby
nursing the professional nurse practitioner assist an
individual, family or community to prevent
or cope with the experience of illness and
suffering, to find meaning in those
experiences (p. 7)
Nursing is viewed as a science of caring.
‘//nursing as the science of caring is
especially oriented toward maximising
the holistic health potential of the
individual and the family’ (p. 240)
Nursing is a planned, care-giving activity
aimed at strengthening the patient’s
ability for self-care, thereby solving or
reducing the patient’s health problem.
This happens in a context of collaboration
and commitment. The nurse helps the
client to strengthen their self-esteem and
search for their own values. The nurse
is the client’s caregiver and advocate

Table 3 Hummelvoll’s (20) four major components in a model of psychiatric nursing

1. Definition of psychiatric nursing Psychiatric nursing is defined as a planned, care-giving, and psychotherapeutic
activity aimed at strengthening the clients ability for self-care, thereby solving
or reducing the clients health problem (p. 7)
2. The context Within the context of a collaborative and committed alliance, the nurse helps
clients to strengthen their self-esteem and search for their own values in life (p. 8)
3. Basis for nursing actions When clients are not able to express their own needs and wishes, the nurse acts
both as caregiver and the client’s advocate (p. 9)
4. Responsibility for the nurse The nurse assumes responsibility for assisting clients to have a life in a gratifying
spirit of social community. On the social level, the nurse has a moral obligation
to influence and change conditions that create health problems (p. 9)

Table 4 The concepts of health, illness and disease

Concept Travelbee Watson Hummelvoll

View of health Health is a state of complete
physical, mental and social
well being
View of illness/disease Travelbee use the term illness
and focus on the individual
reactions to the experience of
and the interpreted meaning
of illness and suffering
Health is: ‘Unity and harmony within the
mind, body and soul. Health is also
associated with the degree of congruence
between the self as perceived and the self
as experienced’ (p. 48)
Illness is not only disease, but also a
disharmony between body, soul and
spirit that may lead to stress
Health is being a whole: a constant
striving to preserve identity and
wellbeing. Health depends, i.a., on
personal judgement and values
Disease is the objective biomedical
perspective, while the term illness
refers to the subjective, experienced
and perceived oriented perspective

of loneliness, longing, aloneness and dissatisfaction that
are embedded and embodied in the self. We also know that
death is inevitable, but this knowledge remains mainly
abstract and theoretical. Travelbee (7) writes: ‘The human
being affirms and denies, acknowledges and rejects,
believes and disbelieves that life’s culminating experiences
will happen to him/her’ (p. 27). Travelbee (7) holds that all
human beings are unique individuals, who are constantly
involved with becoming, evolving or changing. She
acknowledges that every human being has an inherent
value due to his/her being human. Travelbee (7) is critical
to the use of the terms ‘patient’ and ‘nurse’, because using
such terms is to generalize individuals. Consequently, she
uses the terms person, individual, human being, family or
group.
Central in Watson’s theory are human values, such as
kindness, concern and love (Table 1). Watson’s humanis-
tic–altruistic value system is a qualitative philosophy that
guides one’s mature life. People’s capacity to view human
beings with love and to appreciate diversity and individu-
ality is a part of the values system. The value system helps
persons to tolerate differences and to view others through
their perceptual systems rather than through one’s own.
Watson (8) refers to existential humanists, such as Erikson

2003 Nordic College of Caring Sciences, Scand J Caring Sci; 2003; 17, 384–391
388 G.V. Berg, A. Sarvim€
aki
(21), Heidegger (12), Maslow (22) and Rogers and Stevens
(23). Watson believes that the best way to view the human
being is within a framework of developmental conflict and,
furthermore, that a systematic attention to developmental
conflicts of individuals and their families is necessary for
health care.
Hummelvoll (9) has a fundamental belief in the indi-
vidual’s dignity and value as well as respect for human
rights (Table 1). Human beings are comprehensive, and it
is therefore necessary to attain a holistic understanding of
the patient and nursing practice. Man is a unique being
and a complex entity comprising body, soul and spirit in
interaction with the environment. In his model and writ-
ings, Hummelvoll (9) acknowledges a humanistic view and
uses existentialistic-oriented authors, such as Kierkegaard
(24), Buber (25), Heidegger (12), Bollnow (26), May (13)
and Frankl (14). The central assumption in Hummelvoll’s
model (9) is that nursing should be grounded on respect
for the patient’s integrity and autonomy.
View of nursing
Travelbee’s definition of nursing (7) is based on existential
philosophy (Table 2). It is a general definition of nursing
and outlines the scope of responsibility for the nurse’s
work with health, illness and suffering. A central feature of
nursing is the interaction between the nurse and the
individual.
Watson (8) proposes a science of caring and has identified
10 carative factors as crucial to the science of caring
(Table 2). The focus of nursing is to promote health, prevent
illness, give care and restore health. It is important for the
nurse to understand how human beings experience condi-
tions such as sickness, wellness and stress. It is also important
to notice that Watson argues for a balance between a sci-
entific and a humanistic approach in her science of caring.
Hummelvoll’s model (9) is related to psychiatric nursing.
Barbosa da Silva (27) claims that this model is relevant to all
forms of care, including nursing care, as well as to research
in the field of health services. Hummelvoll (20, 28) has
proposed four major components that form the structure in
his model of psychiatric nursing, as shown in Table 3.
View of health, illness and disease
According to Travelbee (7), health is a state of complete
physical, mental and social wellbeing (Table 4). She writes:
‘The process of nursing, i.e. everything the nurse does for
and with the recipient, is designed to help the individual or
family to encounter these experiences’ (p. 10). Travelbee
(7) uses the word illness instead of disease, focuses on
human beings’ reactions to experiences, and the meaning
of illness and suffering.
Watson (8) views health as a process that includes
adaptation, coping and growth throughout an individual’s

2003 Nordic College of Caring Sciences, Scand J Caring Sci; 2003; 17, 384–391
life (Table 4). Health must be viewed within a phenome-
nological perspective, because: ‘Who is to say who is
healthy, except the experiencing person’ (p. 220). Watson
(8) acknowledges WHO’s definition of health as the pos-
itive state of physical, mental and social well-being, but she
believes that other factors need to be included. Therefore,
three elements are added:
1 A high level of overall physical, mental and social
functioning.
2 A general adaptive-maintenance level of daily func-
tioning.
3 The absence of illness (or the presence of efforts that lead
to its absence) (p. 220).
Watson (8) criticizes the traditional health care for being
individualistic and primarily focusing on diagnosing,
prescribing drugs and treatment of illness. This is an
insufficient comprehension of health care, according to
her. Instead, true health care focuses on lifestyle,
life-conditions, and environment. Watson (8) perceives
illness as a disharmony between body, soul and spirit that
may lead to stress. An important view in her writings is
that health should be regarded as a subjective state within
the mind of the person. It is up to the individual to define
his or her state of health or illness.
Hummelvoll (9) writes that health is a complex concept
to understand, because it is ambiguous and not well
defined. Even in a multidimensional view of health the
spiritual component is often missing. With a holistic-exis-
tential approach this component is important, because it
signifies that, when life has meaning this will have a
positive effect on health. The core of health is integration.
The opposite of health is not disease but rather ill-health or
health-deficit that is caused by lack of integration. A sign of
health is wellness, which exists when there is a balance
between and an integration of one’s psychophysical, social
and spiritual abilities to function (20, 28). Hummelvoll (9)
discusses the concepts of illness and disease, and as a
consequence of his existential orientation, he writes that
nurses have to focus on the experiences and perceptions of
illness. This should be the basis of nursing care (Table 4).
Comparison of the main concepts in the two theories
and the model
There are both similarities and differences between the
theories/model in the interpretation and use of the con-
cepts of health, man, nursing and illness/disease. Health is
viewed as an important concept but is interpreted
differently. Watson and Hummelvoll consider health as
something people feel or experience. Their view can be
connected to their interpretations about man, nursing and
distinction between illness and disease. Travelbee (7) uses
the WHO’s definition of health from 1947, and she does
not have the same clarity in her interpretation of health
related to nursing as Watson (8). The theories/model share

the view of nursing as caring or caring-assistance but the
focus of nursing varies. Travelbee (7) views nursing as an
interpersonal process that aims at supporting the individ-
ual in coping with the experiences of illness or suffering.
Watson (8) views nursing as a science of caring, oriented
towards maximizing the holistic health potential of the
individual. Hummelvoll (9) views nursing as a planned
care-giving activity aimed at strengthening the client’s
ability for self-care. His holistic-existential model seems to
have the most comprehensive and concrete view of nur-
sing with regard to health promotion.
Watson emphasizes the importance of caring. Her theory
combines a scientific perspective with a humanistic per-
spective. Hummelvoll encompasses a holistic-existential
approach and use a humanistic perspective. The founda-
tion of all three theories is a humanistic, holistic and partly
existential philosophy, which is manifested in how they
apprehend the concept of human being (Table 1).
There are differences in how health is comprehended
and this has implications for how the theoreticians present
and explain health related to nursing. Furthermore, this
influences how the theories describe nursing activities.
Watson (8) and Hummelvoll (9) emphasize ‘human living’
due to their holistic-existential focus on how people
themselves experience and understand their health. In a
humanistic-oriented approach, health is seen as both a
subjective and dynamic concept. Health is also something
more than the absence of disease or infirmity. Health
concerns the individual’s feeling of wellness and being, an
integrated whole. This view is important in understanding
how nursing practice should be carried out. Therefore, the
focus on individual’s experiences and their perceptions of
the world is important for the nurse.
Synthesis: health promotive nursing with
a holistic-existential approach
A holistic view of nursing represents a focus on specific
human qualities, e.g. self-reflection, experience of mean-
ing, values, feelings and options, all of which also reflect a
humanistic view of man. The humanistic view of man
means that man is regarded as unique, i.e. an autonomous,
rational, social and spiritual being. The holistic-existential
approach in nursing points out that the focus of nursing is
on how the individuals experience their existence, give
meaning to their life-experiences and how they are capable
of being autonomous in concrete situations. From a holis-
tic-existential view it is more relevant to use the term ill-
ness than disease. In this view, disease cannot be attributed
to one isolated organ or part of the body, because disease
affects the whole person in different ways. Illness as a term
refers to a person’s subjective experience and understand-
ing of disease and suffering. This is essential because this
view affects how the concept of health is interpreted, and
furthermore, how nurses interpret and view human being’s

2003 Nordic College of Caring Sciences, Scand J Caring Sci; 2003; 17, 384–391
A holistic-existential approach to health promotion 389
experiences of illness and suffering. In this view of nursing,
human beings, well-being and values are paramount.
Barbosa da Silva (27) says: ‘Common for all forms for
humanistic views, religious or profane, is the understand-
ing of man (as species in relation to other living species) as a
social being who is free, potentially good and rational’
(p. 33). Every person has the right to life and safety, and to
have their integrity, dignity and identity respected. These
ethical assumptions are inherent in the theories of Travel-
bee (7), Watson (8) and Hummelvoll (9) and constitute a
framework for the nurse in creating a dialogue and a rela-
tionship with human beings that seek nursing assistance.
According to Barbosa da Silva (27), the holistic-exis-
tential approach has two important aspects relevant to
nursing. First, this approach looks at human beings on an
individual and societal level. Secondly, it contains mul-
tidimensionality, which permits a complex view of health
and illness. The two aspects also influence the interaction
between the nurse and the individual as well as the for-
mulation of research questions and what kind of research
methods are to be considered appropriate.
A multidimensional view of man distinguishes between
the objective disease and the subjective illness. This dis-
tinction is important for the nurse when approaching the
patients, the phenomenon of health, and in choosing
actions to promote health or prevent illness. The interac-
tion and dialogue between the individual and the nurse is
strongly influenced by the view of man, illness and health.
This idea is central in all the investigated theories.
Hummelvoll (9) argues for an ‘I-Thou-relationship’ (25)
between nurse and patient in his psychiatric-nursing-
model, and this view could also be relevant in other
nursing contexts such as health promotion. In an ‘I-Thou-
relationship’, the nurse and patient regard each other as
subjects. The term ‘subject’ implies that both have
knowledge that is important and relevant in the situation,
that both have possibilities, freedom, rights, in other
words, a relationship characterized by equality (9, 28).
A definition of health promotive nursing with
a holistic-existential approach
Health promotive nursing is, in this paper, based on a
holistic-existential approach and the analysis of central
concepts in three nursing theories. The definition is based
on a humanistic view of man, which focuses on the indi-
vidual’s autonomy, identity, integrity, self-care and self-
esteem as important attributes.
The authors argue that the concept of empowerment
should be added to the stipulative definition. Empower-
ment is defined as giving power or authority to, giving
ability to, enabling and permitting (29), which is consistent
with a humanistic view. Rappaport (30) states that, in a
broad sense, the concept of empowerment is a process by
which individuals, organizations and communities gain
390 G.V. Berg, A. Sarvim€
aki
mastery over their own lives. Empowerment is a transac-
tional concept because the process involves relationships
between human beings. Empowerment was adopted in
WHO’s definition of health promotion in the mid 1980s as
a process of enabling people to increase control over and to
improve their own health. Gibson (29) defines empower-
ment as ‘a process of helping people to assert control over
the factors which affect their health’ (p. 359). Empower-
ment is congruent with a holistic-existential approach and
can also be seen as an outcome of holistic-existential
health promotive nursing approach (9, 27, 29).
The following stipulative definition of health promotive
nursing within a holistic-existential approach is proposed:
Health promotive nursing is planned nursing actions
designed to meet the needs of individuals, families and
communities in their efforts to deal or cope with
health challenges that they presently encounter in
daily life or that might appear in the future. Nursing
activities are based on a holistic-existential approach,
where the human being is viewed as autonomous and
capable of developing self-empowerment in order to
cope with health challenges. The nurse is a human
being with knowledge of how to assist individuals,
families and communities as well as how to facilitate
their development and use of empowerment to pro-
mote health. The aim of nursing is to support human
beings in their need of knowledge and to offer prac-
tical assistance in order to cope with illness experi-
ences and suffering and, thus, to stimulate healthy
living.
A core point in this definition is the view of man, be-
cause this view is essential for how the interplay between
health and illness is interpreted. The following five con-
ditional statements are suggested as necessary for holistic-
existential health promotive nursing.
1 A fundamental positive and respectful attitude in regard
to the values of every human being, their integrity,
autonomy, human rights, and possibilities.
2 A holistic approach in nursing, which implies a view of
man as being a whole, consisting of a physical, psycholo-
gical, social and spiritual dimension.
3 A multidimensional view of health and illness, including
a focus on the individual human being and the human
being in a social context, which promotes a comprehensive
view on health and illness.
4 An existential approach that focuses on ‘the-human-
being-in-the world’, which emphasizes individuals’
experiences of the world as well as their understanding of
their being and the meaning they give their life. The dia-
logue between the individual and the nurse is an essential
part of this condition.
5 The public health perspective guides the direction with
regard to strategies, knowledge and the focus on health.
Health promotion strategies and empowerment are
important issues in this condition.

2003 Nordic College of Caring Sciences, Scand J Caring Sci; 2003; 17, 384–391
The stipulative definition and the five conditions con-
stitute the main premises for a health promotion focus in
nursing. The premises may be seen as idealistic conditions
for a holistic-existential health promotive nursing. The
basis for these conditions is the humanistic view, defini-
tions and statements about the selected concepts (man,
nursing, health and illness) as they are presented in the
selected nursing theories. Furthermore, the view of man
constitutes a frame of reference for the approach towards
the assessment of and actions related to the individual’s
own expression of his/her health need. Through the ana-
lysis of concepts and statements the proposed definition
and conditions create a philosophical as well as practical
basis for health promotive nursing.
Discussion and conclusion
The selected nursing theories/model are analysed with a
focus on their philosophical fundaments, i.e. view of man,
nursing, health and illness/disease. One aspect that is
important to consider is the fact that the theories/model are
formulated in different periods of the nursing history;
Travelbee’s (7) in the late 1960s, Watson’s (8) in the late
1970s and Hummelvoll’s (9, 20, 28) in the 1980s. Travelbee
and Watson are both from USA, while Hummelvoll
represents a Scandinavian tradition. All of them are strongly
influenced by humanism and holistic-existential oriented
philosophy. Watson and Hummelvoll emphasize health as
an important concept and a major concern for nurses.
It is also important to point out that the presented the-
oreticians as such do not present a definition of health
promotive nursing. The proposed definition and the for-
mulated conditions are a result of the synthesis of the
selected nursing theories and an interpretation of a holis-
tic-existential approach in nursing. The definition and
necessary conditions may serve as a preliminary frame-
work for the development of health promotion in nursing
with a holistic-existential approach. It is, however, neces-
sary to explore the definition and conditions further,
before theoretical statements can be formulated, and
specific practical applications can be made. Research,
related to the necessary conditions within different con-
texts and with different research approaches, is necessary
in order to generate theoretical and empirical knowledge.
Thus, this theoretical investigation constitutes the first
stage in a research process that aims at developing a
theoretical and empirical base for health promotive nur-
sing. It is, at this stage, also possible to use the definition
and the conditions as a structure to reflect over or evaluate
the place of health promotion in present nursing practice.
Acknowledgements
The authors would like to thank Professor Jan Kåre
Hummelvoll for his kind and enthusiastic support, for
 A holistic-existential approach to health promotion 391

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2003 Nordic College of Caring Sciences, Scand J Caring Sci; 2003; 17, 384–391