Theoretical Foundations of Nursing

The Evolution of Nursing Discipline and Profession
Introduction to Nursing Theory
“The systematic accumulation of knowledge is essential to progress in any
profession…however; theory and practice must be constantly interactive.
Theory without practice is empty and practice without theory is blind.” –
Cross, 1981
Although nurses of early eras often delivered excellent care to patients, much
of what was known about nursing was not tested or used uniformly in practice
or education.
Profession - Refers to a specialized field of practice, founded on the
theoretical structure of the science or knowledge of that discipline and
accompanying practice abilities
Significance of Theory to Nursing Discipline
 Basis for university baccalaureate programs, developmentof
master’s programs, and standardizationof curriculum
 Doctoralprograms were openedto generate nursing knowledge
 Discipline is dependenton theoryfor its existence
 Provides nurses a perspective of the patient for professional
practice

Nursing practice was based on principles and traditions that were handed
down through apprenticeship.
FLORENCE NIGHTINGALE - envisioned nurses as a body of educated
women at the time when women are not educated nor employed in public
service
 Pioneering activities in nursing practice and education and her
subsequent writings became a guide for establishing nursing
schools and hospitals in the US at the beginning of the 20th
century
Nurse’s function: putting the patient in the best condition for nature to act
upon him and based on knowledge of persons and their surroundings.
Nursing as a vocation to a profession is based on the search for substantive
nursing knowledge on which to base nursing practice.
Theory development in nursing has evolved rapidly over the past 6 decades,
leading to the recognition of nursing as an academic discipline with a
specialized body of knowledge.
A major goal was put forthby nursing leaders in the 20th century forthe
development of nursing knowledge on which to base nursing practice,
improve quality of care, and gain recognition of nursing as a profession.
Characteristics of a Profession
1. Utilizes in its practice a well-organized body of specialized
knowledge that is an intellectual level of the higher learning
2. Constantly and largest the body of knowledge it uses and improves
its techniques of education and service through the use of scientific
method
3. Entrust the education of its practitioners to institutions of higher
education
4. Applies its body of knowledge in practical services vital to human
and social welfare
5. Functions autonomously in the formulation of professional policy
and thereby in the control of professional activity
6. Attracts individuals with intellectual and personal qualities of
exalting service above personal gain who recognize their chosen
occupation as a life work
7. Strives to compensate its practitioners by providing freedom of
action, opportunity for continuous professional growth, and
economic security
Significance of Theory to Nursing Profession
 Recognition of nursing as a profession
 Constant growth of the body of nursing knowledge
 Evidence-based nursing practice
 Tool for reasoning, critical thinking, and decision-making for safe
and quality nursing practice

Nurse scholars led the search forspecialized

theoretical nursing knowledge to guide NURSING THEORISTS OF HISTORICAL SIGNIFICANCE
education, professional practice, research, and
administration. Hildegard E. Peplau
Theory of Interpersonal Relations
Nursing followed a developmental path from
concepts to conceptual frameworks to models  Peplau is described as the mother of psychiatric nursing because
to theories to practice-level middle-range her theoretical and clinical work led to the development of the
theories in the theory utilization era. distinct specialty field of psychiatric nursing.
 She stressed the importance of nurses’ ability to understand their
Historical Eras of Nursing’s Search for Specialized Knowledge own behavior to help others identify perceived difficulties.
Histori Perio Major Emphasis Ourcome Emerging  She described the importance of the nurses-patient relationship as a
cal Era d Question s Goal significant therapeutic interpersonal process.
Curricul 1900- What Courses Standardi Develop  Nurses should apply the principles of human relations to the
um Era 1940’ curriculum included zed specialized
s content in nursing curricula knowledge problems that arise at all levels.
should programs for and higher  Her book entitled “Interpersonal Relations in Nursing” published
student diploma education in 1952 is recognized as the first nursing theory textbook
nurses programs
studyto be since Nightingale’s work in the 1850’s
nurses?
Researc 1950’ What is the Role of Problem Isolated
h Era s- focus for nurses and studies studies do
1970’ nursing what to and not yield
s research? search studies of unified
nurses knowledge
Graduat 1950’ What Carving Nurses Focusgradu
e s- knowledge is out an have an ate
Educati 1970’ needed for advanced important education
on Era s the practice role and role in on
of nursing? basis for health knowledge
nursing care developme
practice nt
Theory 1980- How dothese There are Nursing Theories Virginia Henderson
Era 1990’ frameworks many theoretica guide Definition of Nursing
s guide ways to l works nursing
research and think shift the research
practice? about focusto and  Henderson viewed the patient as an individual who requires help
nursing. the practice toward achieving independence and completeness or wholeness of
patient.
Theory 21st What new Nursing Middle- Nursing mind and body.
utilizati Centu theories are theory range framework  She clarified the practice of nursing as independent form of the
on ry needed to guides theory s produce practice of the physicians and acknowledged her interpretation of
produceevide research, may be knowledge the nurse’s role as a synthesis of many influences.
nce practice, from (evidence)
for quality education, quantitati for
care? and ve or quality care Henderson identified three (3) levels of nurse-patient relationship in which the
administra qualitativ
tion e nurse acts as:
approache 1. A substitute for the patient
s. 2. A helper to the patient
3. A partner with the patient

Nursing history and significant developments demonstrate the incredible
influence theory has had on nursing as a specialized field of practice
(profession) and a division of education (discipline).
Discipline - Specific to academia and refers to a branch of education, a
department of learning, or a domain of knowledge
The unique function of the nurse is to assist the individual, sick or well, in the
performance of those activities contributing to health or its recovery (or to
peaceful death) that he would perform unaided if he had the necessary
strength, will, or knowledge; and to do this in such a way as to help him gain
independence as rapidly as possible.

Faye Glenn Abdellah

 Theoretical Foundations of Nursing
Twenty One Nursing Problems The nurse validates that the need for help
was met.
• Abdellah is recognized as a leader in the development of nursing
research and nursing as a profession within the US Public Health
Lydia Hall
Service and as an international expert on health problems.
Core, Care, and Cure Model
• Her work, which is based on problem-solving method, serves as a
• Hall believed that professional nursing care hastened recovery, and
vehicle for delineating nursing problems as the patient moves
as less medical care was needed, more professional nursing care
toward a healthy outcome.
and teaching were necessary.
• Abdellah views nursing as an art and a science that mold attitude,
• Hall used three interlocking circles to represent aspects of the
intellectual competencies, and technical skills of the individual
patient and nursing functions.
nurse into the desire and ability to help individuals cope with their
• The three circles change in size and overlap in relation to the
health needs, whether they are ill or well.
patient’s phase in the disease process.
• Abdellah’s work is a set of problems formulated in terms of
nursing-centered services, which are used to determine the
patient’s needs.

21 Nursing Problems (Purpose: to guide care & promote use of nursing

judgment)
1. to promote good hygiene and physical comfort
2. to promote optimal activity, exercise, rest, and sleep
3. the promote safety through prevention of accidents, injury, or other
trauma and through the prevention of the spread of infection
4. to maintain good body mechanics and prevent and correct
deformities
5. to facilitate the maintenance of a supply of oxygen to all body cells
Joyce Travelbee
6. to facilitate the maintenance of nutrition of all body cells
Human-to-Human Relationship
7. to facilitate the maintenance of elimination
8. to facilitate the maintenance of fluid and electrolyte balance
• Travelbee proposed that the goal of nursing was to assist an
9. to recognize the physiologic responses of the body to disease
individual, family, or community to prevent or cope with the
conditions
experience of illness and suffering and, if necessary, to find
10. to facilitate the maintenance of regulatory mechanisms and
meaning in these experiences, with the ultimate goal of being the
functions
presence of hope.
11. to facilitate the maintenance of sensory function
• She proposed that nursing was accomplished through human-to-
12. to identify in except positive and negative expressions, feelings,
human relationships that began with the original encounter and
and reactions
progressed through stages of emerging identities, developing
13. to identify and accept the interrelatedness of emotions and organic
feelings of empathy and, later, sympathy, until the nurse and the
illness
patient attained rapport in the final stage.
14. to facilitate the maintenance of effective verbal and nonverbal
communication
15. to promote the development of productive interpersonal
Kathryn E. Barnard
relationships
Child HealthAssessment
16. the facilitate progress toward achievement of personal spiritual
• Kathryn E. Barnard was an internationally recognized pioneer in
goals
the field of infant mental health, which studies the social and
17. to create and maintain a therapeutic environment
emotional development of children during their first 5 years of life.
18. to facilitate awareness of self as an individual with varying
• She was the founder of the Nursing Child Assessment Satellite
physical, emotional, and developmental needs
Training Project (NCAST), providing health care workers around
19. to accept the optimum possible goals in light of physical and
the globe with guidelines for assessing infant development and
emotional limitations
parent-child interactions.
20. to use community resources as an aid in resolving problems arising
• Barnard proposed that individual characteristics of members
from illness
influence the parent-infant system, and adaptive behavior modifies
21. to understand the role of social problems as influencing factors in
those characteristics to meet the needs of the system.
the cause of illness

10 Steps in Identifying a Problem

Evelyn Adam
1. learn to know the patient
Conceptual Model for Nursing
2. sort out relevant insignificant data
3. make generalizations about available data in relation to similar
• Her work focuses on the development of models and theories on
nursing problems presented by other patients
the concept of nursing.
4. identify the therapeutic plan
• Adam included the goal of the profession, the beneficiary of the
5. test generalizations with the patient and make additional
professional service, the role of the professional, the source of the
generalizations
beneficiary’s difficulty, the intervention of the professional, and
6. validate the patient's conclusions about his nursing problem
the consequences.
7. continue to observe and evaluate the patient over a period of time
to identify any attitudes and clues affecting their behavior
8. explore the patients and family's reaction to the therapeutic plan
IDAJEAN ORLANDO-PELLETIER
and involve them in the plan
Nursing Process Theory
9. identify how the nurse feels about the patient's nursing problems
10. discuss and develop a comprehensive care plan
• Orlando’s nursing theory stresses the reciprocal relationship
between the patient and nurse.
• Orlando was one of the early thinkers in nursing who proposed that
Ernestine Weidenbach
patients have their own meanings and interpretations of situations
The Helping Art Of Clinical Nursing
and therefore nurses must validate their inferences and analyses
with patients before drawing conclusions (Meleis, 2012).
• She is known for her work in theory development and maternal
• According to Orlando, persons become patients who require
infant nursing developed while teaching maternity nursing at the
nursing care when they have needs for help that cannot be met
Yale University School of Nursing.
independently because they have physical limitations, have
• She described nursing as: People may differ in their concept of
negative reactions to an environment, or have an experience that
nursing, but few would disagree that nursing is nurturing or caring
prevents them from communicating their needs.
for someone in a motherly fashion.
• Patients experience distress or feelings of helplessness as the result
• Wiedenbach postulated that clinical nursing is directed toward
of unmet needs for help.
meeting the patient’s perceived need for help in a vision of nursing
• There is a positive correlation between the length of time the
that reflects considerable emphasis on the art of nursing.
patient experiences unmet needs and the degree of distress.
• Orlando views the professional function of nursing as finding out
and meeting the patient’s immediate need for help.
The nurse identifies patient’s need
for help.

The nurse administers the help needed.

 Theoretical Foundations of Nursing
Nancy Roper, Winifred W. Logan, Alison J. Tierney
A Model for Nursing based on a Model of Living
• The five components can be used to describe the individual in
relation to maintaining health, preventing disease, coping during
periods of chronic ill health, and coping when dying.
• Individualizing nursing is accomplished by using the process of
nursing – assessing, planning, implementing, and evaluating.
• The nursing process is a method of logical thinking that should be
used with an explicit nursing model, and the patient’s individuality
in living must be borne in mind during all four phases of the
process.
History and Philosophy Of Nursing Science
Science is a method for describing, explaining, and predicting
causes or outcomes of interventions
Scientific activity has helped to establish the evidence we use to
guide practice in the delivery of nursing care.
Rationalism
Rationalist epistemology emphasizes the importance of a priori
reasoning as the appropriate method for advancing knowledge
A priori reasoning uses deductive logic by reasoning from the
cause to an effect or from generalization to a particular instance.
However, this causal reasoning is a theoretical assertion until
tested and disproven.
As the continuous interplay between theory construction and
testing with empirical research progresses, the theory becomes more precise
and complete as a description of nature, and therefore, more useful for the
goals of science.
Empiricism
Scientific knowledge can be derived only from sensory experience.
Scientific truth was discovered through generalizing observed facts
in the natural world.
Rationalism Empiricism
Theory-then-research Research-then-theory
Strategy strategy
Deductive and Inductive and
Quantitative qualitative
Positivism Empirical research
& logical analysis were
two approaches that
would produce scientific
Rationalism Empiricism knowledge
Theoretical propositions
must be tested through
observation and
experimentation
Foucault (1973) stated that empirical knowledge was arranged in
differentpatterns at a given time and in a given culture and that humans were
emerging as objects of study.
Brown (1977) argued that observations are concept-laden.
ASSUMPTIONS OF EMERGENT VIEWS OF SCIENCE
• Scientists are merely passive observers of occurrences in the
empirical world. Observable data are objective truth waiting to be
discovered.
• Theories structure what the scientist perceives in the empirical
world.
• Presupposed theories and observable data interact in the process of
scientific investigation.
Science is viewed as an on going process. Tentative consensus of
scientists in any given historical era regard as scientific knowledge.
What we understand today as the best approach to patient care
based upon the current science may change with time.
STRUCTURE OF NURSING KNOWLEDGE
Concepts & Definitions
• Concepts are the building blocks of theories.
• It is crucial that concepts are considered within the theoretical
system in which they are embedded and from which they derive
their meaning, because concepts may have different meanings in
various conceptual frameworks or theoretical systems.
• Abstract concepts are mentally constructed independent of a
specific time or place, whereas concrete concepts are directly
experienced and relate to a particular time or place.
• Typologies are systematic arrangements of concepts within a
category. There are no degrees.
• Continuous concept permits classification of dimensions or
gradations of a phenomenon.
• The development of concepts permits the description and
classification of phenomena (Hage, 1972).
• Concept analysis is an important beginning step in the process of
theory development to create a conceptual definition.
• It is crucial that concepts are clearly defined within the conceptual
model or framework to reduce the ambiguity in the given concept
or set of concepts.
• To eliminate perceived differences in meaning, explicit definitions
are necessary.
• As the theory develops, theoretical and operational definitions
provide the theorist’s meaning of the concept and the basis for the
empirical indicators.
RELATIONAL STATEMENTS
• Relational statements propose relationships between and among
two or more concepts.
• In the connections between variables, one variable (independent)
may be proposed to influence a second (dependent).
• A sufficient condition (if) means that one variable results in
another variable occurring. A necessary condition (only if / if…
then) asserts that one variable is required for the occurrence of
another variable.
LINKAGES & ORDERING
• Development of theoretical linkages provides an explanation of
why the variables are connected in a certain manner; that is, the
theoretical reason for particular relationships.
• Operational linkages contribute a perspective for understanding the
nature of the relationship between concepts, to know whether the
relationship between the concepts is positive or negative, linear or
curvilinear.
PHILOSOPHY
• Sets forth the meaning of nursing phenomena through analysis, reasoning,
and logical presentation of concepts and ideas
 Theoretical Foundations of Nursing
CONCEPTUALMODELS
• Sets of concepts that addresses phenomena central to nursing in propositions
that explain the relationship among them
GRAND THEORY
• Derives from conceptual model and proposes an abstract testable theory
NURSING THEORY
• Comprises works derived from nursing philosophies, conceptual models,
grand theories, abstract nursing theories, or works in other disciplines
MIDDLE-RANGETHEORY
• Proposes precise testable nursing practice questions; they address the
specifics of nursing situations within the perspective of the model, grand
theory, or theory from which they originate.
NURSING PHILOSOPHIES
Florence Nightingale
The Environmental Theory
CREDENTIALS & BACKGROUND OF THE THEORIST
• Born on May 12, 1820 in Florence, Italy
• She developed a sense that her life should become more useful.
• In 1837 (17 years old), she wrote in her diary: “God spoke to me
and called me to his service.” (Holliday and Parker, 1997)
• She completed her nursing training for 3 months in 1851 (31 years
old)at Kaiserwerth, Germany.
• Among her jobs include the following:
a. Examiner of hospital facilities, reformatories, and
charitable institutions
b. Superintendent of the Hospital for Invalid
Gentlewomen, London
c. Respondent with 34 nurses in the Crimean War in
Scutari, Turkey as commanded by Sidney Herbert, the
Secretary of War
• The Lady of the Lamp - She made rounds during the night,
providing emotional comfort to the soldiers.
• During the war, she became critically ill due to typhus or
brucellosis which may physical condition afterwards. with fever
probably have affected her
• After returning from the war, she was awarded funds in recognition
of her work which she used to establish the School of Nursing at
St. Thomas’ Hospital and King’s College in London.
• Within a few years, the Nightingale School received requests all
over the world to establish nursing schools in hospitals.
• She was able to work into her 80’s until she lost her vision.
• Died on August 13, 1910 in London
SOURCES FOR THEORY DEVELOPMENT
• During the war, the mortality rate of wounded soldiers was
incredibly high.
• Nightingale observed that environmental problems existed (i.e.
lack of sanitation, few chamber pots, contaminated water,
contaminated bed linens, and overflowing cesspools), including
frostbite, louse infestations, wound infections, and opportunistic
diseases.
• Nightingale’s work in improving the environmental conditions
made her popular and revered person to the soldiers, but not with
physicians and military officers.
• She extended her work to improve the living environment of the
poor, create social change, army sanitation reform, functions of
army hospitals, sanitation in India and in England.
• Nightingale also recognized the societal changes of her time and
their impact on the health status of individuals.
• Her belief that action for the benefit of others is a primary way of
serving God served as the foundation for defining her nursing work
as a religious calling.
NURSING METAPARADIGM
• Nursing is being responsible for someone else’s health. Trained
nurses were to learn additional scientific principles to be applied in
their work and to be more skilled in providing care.
• Person is referred to as the patient in which the nurse performs
tasks to and for. The nurse, however, asks his/her preferences.
• Health is being well and using every power to the fullest extent in
living life. Maintenance of health is through the prevention of
disease by environmental control and social responsibility.
• Environment is part of nature that influences the healing of the
patient.
THEORETICAL ASSERTIONS
• Nightingale believed that disease was a reparative process; disease
was nature’s effort to remedy a process of poisoning or decay, or it
was a reaction against the conditions in which a person was placed.
• Nightingale believed that healthy surroundings were necessary for
proper nursing care and the restoration and maintenance of health.
• Nightingale believed that the role of nursing was to prevent an
interruption of the reparative process and to provide optimal
conditions for its enhancement.
• Nightingale believed that people desired good health, that they
would cooperate with the nurse and nature to allow their reparative
process to occur, and that they would alter their environment to
prevent disease
• Five essential components of environmental health:
1. Pure air
2. Light
3. Cleanliness
4. Efficient drainage
5. Pure water
APPLICATIONS TO NURSING
• The environmental aspects of her theory remain integral
components of nursing care.
• Nurses and nursing have an active role in becoming involved in
social and political arenas to ensure healthy environment for all
citizens.
• Occupational health nursing
• Infection prevention and control
• Nightingale understood that good practice could result only from
good education.
• It is difficult to imagine what the care of sick human beings would
be like if Nightingale had not defined the educational needs of
nurses and established the first nursing schools.
Jean Watson
Philosophy and Theory of Transpersonal Caring
CREDENTIALS & BACKGROUND OF THE THEORIST
• Born on June 10, 1940 in Welch, West Virginia
• She and her colleagues established the Center for Human Caring
at the University of Colorado which uses human caring knowledge
for clinical practice, scholarship, administration, and leadership.
• She also established the Watson Caring Science Institute (WCSI)
devoted to advancing caring science in Global World Caring
Science programs and projects.
• She developed a post baccalaureate nursing curriculum in human
caring, health and healing that led to the Doctor in Nursing
Practice (DNP).
SOURCES FOR THEORY DEVELOPMENT
• Watson attributes her emphasis on the interpersonal and
transpersonal qualities of congruence, empathy, and warmth to
Carl Rogers and more recent writers of transpersonal psychology.
• Watson points out that Carl Rogers’s phenomenological approach,
with his view that nurses are not here to manipulate and control
others but rather to understand, was profoundly influential at a time
when “clinicalization” was considered the norm.
• Watson describes transpersonal caring relationship as a special
kind of human care relationship - a union with another person -
high regard for the whole person and their being-in-the-world.
• Nursing consists of knowledge, thought, values, philosophy,
commitment, and action, with some degree of passion. Nurses are
interested in understanding health, illness, and the human
experience; promoting and restoring health; and preventing illness.
• Person (human being, life, personhood, self)is a unity of
mind/body/spirit/nature. Humans cannot be treated as objects and
that humans cannot be separated from self, other, nature, and the
larger universe.
• Health is the unity and harmony within the mind, body, and soul,
associated with the degree of congruence between the self as
perceived and the self as experienced. Illness is not necessarily
disease but a subjective turmoil or disharmony within a person’s
inner self or soul at some level of disharmony within the spheres of
the person (e.g. mind, body, and soul), either consciously and
unconsciously.
• Environment must be supportive, protective, or corrective in the
mental, physical, societal and spiritual aspects. Healing spaces can
be used to help others transcend illness, pain, and suffering.
THEORETICAL ASSERTIONS
• Moral commitment, intentionality, and caritas consciousness by the
nurse protect, enhance, and potentiate human dignity, wholeness
 Theoretical Foundations of Nursing
and healing, thereby allowing a person to create or co-create
his/her own meaning for existence.
• The conscious will of the nurse affirms the subjective and spiritual
significance of the patient while seeking to sustain caring in the
midst of threat and despair. The result is an I-thou relationship
rather than an I-it relationship.
• The nurse seeks to recognize, accurately detect, and connect with
the inner condition of spirit of another through genuine presence
and by being centered in the caring moment.
• The nurse’s ability to connect with another at this transpersonal
spirit-to-spirit level is translated into nursing science and art.
• The caring-healing modalities within the context of transpersonal
caring/caritas consciousness potentiate harmony, wholeness, and
unity of being by releasing some of the disharmony; thus, the nurse
helps through this process to access the healer within.
• Caritas consciousness is defined as an awareness and intentionality
that forms the foundation for the caritas nurse.
CARATIVE FACTORS CARITAS PROCESSES
The formation of humanistic- Cultivating the practice of loving-
altruistic system of values kindness and equanimity toward
self and other as foundational
to caritas consciousness
The instillation of faith-hope Being authentically present and
enabling and sustaining the deep
belief system and subjective life-
world of self and one being cared
for
The cultivation of sensitivity to Cultivation of one’s own
one’s self and to others spiritual practi ces and
transpersonal self, going beyond
the ego self
Development of a helping- Developing and sustaining a
trusting human caring relation helping trusting authentic
congruence, caring, empathy,
relationship
non possessive (through
warmth, and effective
communication)
The promotion and acceptance Being present to, and
of the expression of positive and supportive of the expression of
negative feelings positive and negative feelings
The systematic use of creative problem Creative use of self and all ways
solving caring of knowing as part of the caring
process process; to engage in the artistry
of caring-
healing practices
The promotionof transpersonal teaching- Engaging in genuine teaching-
learning learning experience that attends to
unity of being and meaning,
attempting to stay within others’
frame of reference.
The provision of supportive, protective, Creating healing environment at
and/or corrective mental, physical, all levels
societal, and spiritual
environment
The assistance with gratification of Assisting with the basic needs,
human needs with an intentional caring
consciousness,
administering human care
essentials, which potentiate
alignment of mind, body, and
spirit, wholeness, and unity of
being in all aspects of care
The allowance of existential- Opening and attending to
phenomenological-spiritual forces spiritual-mysterious and
existential dimensions of one’s
own life-death, soul care for self
and the one-being-cared-for
APPLICATIONS TO NURSING
• Watson’s theory has been validated in outpatient, inpatient, and
community health clinical settings and with various populations
(e.g. attention to patient care essentials, living on ventilator,
simulating care, mothers struggling with mental illness, and
women with infertility).
• 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.
• Linking of caring science and quantum leadership
Patricia Benner
From Novice to Expert: Stages of Clinical Competence
CREDENTIALS & BACKGROUND OF THE THEORIST
• Born on August 31, 1942 in Hampton, Virginia
• Along with her husband, Richard Benner, she consults
around the world regarding clinical practice development
models (CPDM’s).
SOURCES FOR THEORY DEVELOPMENT
• Benner studies clinical nursing practice in an attempt to
discover and describe the knowledge embedded in nursing
practice.
• She maintains that knowledge accrues over time in a practice
discipline and is developed through experiential learning,
situated thinking, and reflection, on practice in particular
practice situations.
• She stated that knowledge development in a practice
discipline consists of extending practical knowledge through
theory-based scientific investigations and through clinical
experience in the practice of that discipline.
• Clinical situations are always more varied and complicated
than theoretical accounts; therefore, clinical practice is an
area of inquiry and a source of knowledge development.
• By studying practice, nurses uncover new knowledge.
• Theory is derived from practice, and practice is extended by
theory.
NURSING METAPARADIGM
• Nursing, described as a caring relationship, is an enabling
condition of connection and concern. Caring is primary because
caring sets up the possibility of giving help and receiving help.
• A person is a self-interpreting being, that is, the person does not
come into the world predefined but gets defined in the course of
living a life.
• Health is defined as what can be assessed, whereas well-being is
the human experience of health or wholeness.
• Situation (environment) conveys a social environment with social
definition and meaningfulness.
THEORETICAL ASSERTIONS
The model posits that changes in four aspects of performance
occur in movement through the levels of skill acquisition:
a. Movement from a reliance on abstract principles and rules to
the use of past, concrete experience;
b. Shift from reliance on analytical, rule-based thinking to
intuition;
c. Change in the learner’s perception of the situation from
viewing it as a compilation of equally relevant bits to viewing
it as an increasingly complex whole, in which certain parts
stand out as more or less relevant; and,
d. Passage from a detached observer, standing outside the
situation, to one of a position of involvement, fully engaged
in the situation.
• Benner noted that experience-based skills acquisition is safer and
quicker when it rests upon a sound educational base.
• Benner defines skill and skilled practice as implementing skilled
nursing interventions and clinical judgment skills in actual clinical
situations.
• As the nurse gains experience, clinical knowledge becomes a blend
of practical and theoretical knowledge.
• Expertise develops as the clinician tests and modifies principle-
based expectations in the actual situation.
• This model assumes that all practical situations are far more
complex that can be described by formal models, theories, and
textbook descriptions.
• Clinical knowledge is embedded in perceptions rather than
precepts.
THEORETICAL ASSERTIONS
LEVEL OF EXPERTISE DESCRIPTION
 The nurse has no background
experience of the situation in which
he/she is involved.
 Context-free rules and objective
attributes must be given to guide
performance.
Novice
 There is difficulty discerning between
relevant and irrelevant aspects of a
situation.
 The person acceptable can
demonstrate marginally performance,
having coped with enough real
 Theoretical Foundations of Nursing
situations to note, or to have pointed
out by a mentor, the recurring
meaningful components of the
situation.
 Nurses functioning at this level are
guided by rules and are oriented by
task completion. They have difficulty
grasping the current patient situation
in terms of the larger perspective.
 Clinical situations are viewed by
nurses as a test of their abilities and
Advanced Beginner the demands of the situation placed on
them rather than in terms of patient
needs and responses.
 Conscious and deliberate planning that
determines which aspects of current
and future situations are important and
which can be ignored.
 The level of efficiency is increased but
the focus is on time management and
the nurse’s organization of tasks rather
Competent than on timing in relation to patient’s
needs.
 The performer perceives the
situation as a whole rather than in
terms of aspects, and the performance
is guided by maxims.
 Nurses at this level demonstrate a new
ability to see changing relevance
in a situation, including recognition
and implementation of skilled
Proficient responses to the situation as it evolves.
 There is much more involvement with
the patient and the family.
 The performer no longer relies on
analytical principle to connect an
understanding of the situation to an
appropriate action.
 The nurse has an intuitive grasp of the
situation and is able to identify the
region of the problem without losing
time considering a range of alternative
diagnoses and solutions.
 Meeting the patient’s needs and actual
Expert concerns is of utmost importance.
APPLICATIONS TO NURSING
 Usefulness for preceptor development, orientation programs, and
career development
 Basis for differentiating clinical knowledge development and
career progression in nursing
 Career ladders and succession plans
 Competency-based testing
 2012 National Nursing Core Competency Standards
 Philippine Qualifications Framework
 Philippine Nursing Career Progression Program
 Continuing Professional Development Act of 2016
KATIE ERIKSSON
Theory of Caritative Caring
 The innermost spirit of a human being as a synthesis of the eternal
and temporal, and that acting ethically is to will absolutely or to
will the eternal.
NURSING METAPARADIGM
 Caritas constitutes the motive for caring, and it is through the
caritas motive that caring gets its deepest formulation. The
fundamentals of natural caring are constituted by the idea of
motherliness, which implies cleansing and nourishing, and
spontaneous and unconditional love.
 The human being is fundamentally an entity of body, soul, and
spirit; hence, holy and a religious being.
 Health is more than the absence of illness. Health implies
wholeness and holiness.
 Ethos, which forms the basic force in caring culture, reflects the
prevailing priority of values through which the basic foundations
of ethics and ethical actions appear.
THEORETICAL ASSERTIONS
 Human dignity means accepting the human obligation of serving
with love, of existing for the sake of others.
 Communion is the basis for all humanity
 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.
 The human being lives in a reality that is characterized by mystery,
infinity, and eternity.
 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.
 Caring implies alleviation of suffering in charity, love, faith, and
hope.
 The caritas motive, the ethos of love and charity, and the respect
and reverence for human holiness and dignity, which determine the
nature of caring, give the caritative caring theory its feature.
 In the act of caring, the suffering human being, or patient is invited
and welcomed to the caring communion, where the patient’s
suffering can be alleviated through the act of caring in the drama of
suffering which is unique to every human being.
APPLICATIONS TO NURSING
 Because Eriksson’s thinking and process model of caring are
general, the nursing care process model has proved to be applicable
in all contexts of caring, from acute clinical caring and psychiatric
care to health-promoting and preventive 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.
 Development of the caring science-centered curriculum and
caring didactics continued in the educational and research program
in caring science didactics.

CREDENTIALS & BACKGROUND OF THE THEORIST

 Born on November18, 1943 in Jakobstad, Finland
 She is one of the pioneers of caring science in the Nordic countries.
 Those who followed her work and progress in Finland have
noticed her ability from the beginning to design caring science as a
discipline, while bringing to life the abstract substance of caring.
 She has systematically deepened her thoughts about caring, partly
through development of an ideal model for caring that formed the
basis for the caritative caring theory, and partly through the
development of an autonomous, humanistically oriented caring
science.

SOURCES FOR THEORY DEVELOPMENT

 Since the 1970’s Eriksson’s leading thoughts have been not only to
develop the substance of caring, but also to develop caring science
as an independent discipline.
 Her theory is influenced by the idea that human science cannot
exist without values.
 The call to serve precedes dialogue, that ethics is always more
important in relations with other human beings. The fundamental
substance of ethics is caritas, love, and charity.