TFN REVIEWER
worldview of a discipline—the global
Chapter 1 and 2
Definition of Terms
 Assumptions are beliefs about
phenomena perceived as true to
accept a theory and may not be
susceptible to testing.
 Concepts are the elements or
components of a phenomenon
necessary to understand the
phenomenon. They are abstract and
derived from impressions the human
mind receives about phenomena
through sensing the environment.
 A conceptual model is a set of
interrelated concepts that
symbolically represents and conveys
a mental image of a phenomenon.
 Hypotheses are tentative
suggestions that a specific
relationship exists between two
concepts or propositions. As the
hypothesis is repeatedly confirmed,
it progresses to an empirical
generalization and ultimately to a
law.
 Knowledge refers to the awareness
or perception of reality acquired
through insight, learning, or
investigation. In a discipline,
knowledge is what is collectively
seen to be a reasonably accurate
understanding of the world as seen
by members of the discipline.
 Law is a proposition about the
relationship between concepts in a
theory that has been repeatedly
validated. Laws are highly
generalizable. Laws are found
primarily in disciplines that deal with
observable and measurable
phenomena, such as chemistry and
physics. Conversely, social and
human sciences have few laws.
 Metaparadigm represents the
perspective that subsumes more
specific views and approaches to the
central concepts with which the
discipline is concerned. The
metaparadigm is the ideology within
which the theories, knowledge, and
processes for knowing find meaning
and coherence.
 Models are graphic or symbolic
representations of phenomena that
objectify and present certain
perspectives or points of view about
nature or function or both. Models may
be theoretical (something not directly
observable—expressed in language or
mathematics symbols) or empirical
(replicas of observable reality—model
of an eye, for example).
 Paradigm is an organizing framework
that contains concepts, theories,
assumptions, beliefs, values, and
principles that form the way a
discipline interprets the subject matter
with which it is concerned. It describes
work to be done and frames an
orientation within which the work will
be accomplished. A discipline may
have a number of paradigms.
 Propositions are statements of a
constant relationship between two or
more concepts or facts; suggestion;
opinion
 Philosophy is a statement of beliefs
and values about human beings and
their world.
 Theory refers to a set of logically
interrelated concepts, statements,
propositions, and definitions, which
have been derived from philosophical
beliefs of scientific data and from
which questions or hypotheses can be
deduced, tested, and verified. The
primary distinction between a
conceptual model is the level of
abstraction.
 Theory
 NURSING THEORY-
“conceptualization of some
aspect of reality (invented or
discovered) that pertains to
nursing. The conceptualization
is articulated for the purpose of
describing, explaining,
predicting or prescribing nursing
care.” (Meleis,1994)
Characteristics of Theory
 Logical, simple and generalizable
 Composed of concepts and
propositions
 Provide the bases for testable
hypotheses
 Consistent with other validated
theories
 Contribute to body of knowledge
Components of Theory
 Purpose - P
 concepts and definitions -C & D
 theoretical statements - TS
 structure/linkages and ordering -
S/L & O
 assumptions - A
Lesson 1: Introduction to Nursing
Theory
History of Nursing Theory
FLORENCE NIGHTINGALE
 Half of 20th century-Nursing as a
discipline
 Theory to guide nursing practice
is essential
21ST CENTURY:
 Theory- patient focus and
framework to sort patient data in
practice
 Guides thinking and nursing
action
 Theory informs practice and vice
versa
 “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, p. 110).
NURSING THEORY
 Nurse is derived from the Anglo-
French nurice and the Latin
nutrica, both of which mean
nourish.
 Conceptualization of some
aspect of nursing reality
communicated for the purpose of
describing phenomena,
explaining relationships between
phenomena, predicting
consequences or prescribing
nursing care, Meleis 2007.
 Knowledge based concept; it
defines what nursing practice is.
 Organized body of knowledge
what nurses do, what nursing is
and all concepts of nursing
practices
 Provides a way to define nursing
as a unique discipline separate
from other disciplines.
 Body of knowledge unique only to
nursing. Guides the practice of
nursing.
Highlights of Significant Events in
Nursing History
 1859- Nightingale served in the
Crimean war and set up a holistic
system of nursing .Environmental
view of nursing. Notes on
Nursing- 1st nursing theory that
focuses on manipulation of the
environment for patient’s benefit;
created a timeless legacy for the
nursing profession
 1950s- (1956) Columbia
University(top2) school of
Nursing offered the first masters
program for nurses
 1952-1953 Hildegard introduced
her theory about interpersonal
relations. Nurse-patient
relationship.
 1960- Nurse practitioner
movement at Yale University
School of Nursing
 1970- Several nursing theories
had been published/Nursing
theories were presented
 1980- Nursing theories were
revised and findings that
expanded them
 1990- Research studies that
tested and expanded nursing
theory were numerous
 2000- Less new theories, more
revised and updated theories,
evidence-based practice
Eras of Nursing Knowledge
1. Curriculum Era-CE
2. Research Era-RE
3. Graduate Education Era-GEE
4. Theory Era-TE
5. Theory Utilization Era-TUE
Curriculum Era (1900-1940s)
 Emphasis: curricular content and
the movement toward the goal of
a standardized curricula
- to develop specialized knowledge
and higher education
 Expansion of curricula beyond
physiological and
pathophysiological knowledge to
social sciences, pharmacology
and nursing procedures. The
contents were initially included in
“Fundamentals” (basic
essentials) then it goes beyond
knowledge on patient’s illness.
 Difference between medical and
nursing view of patients became
distinct because of Nightingale.
- “art of nursing” was changed to
“science of nursing”; Baccalaureate
nursing programs in higher learning
emphasis is on science --- Presently,
“art and science of nursing” is more
supported.
- Emergence of “nursing arts
laboratory” (nursing procedures are
practiced in ward-like room); skills
lab (science and research)
Research Era (1950-1970s)
 Research became the driving
force. Nurses were encouraged
to learn how to conduct research,
developing the role for nurses for
that specialized body of
knowledge.
 Research is the basis of nursing
practice.
  Emphasis: scholarship; the need
to disseminate research findings
in scholarly publications
Graduation Era (1950-1970s)
 Curricula for master’s- level
preparation included nursing
research, clinical specialty
practice and leadership.
 Nurses advance to doctorate
programs from a wide range of
related disciplines as they were
being prepared for research and
teaching roles in nursing
 Series of conferences bought
nurses to exchange ideas that
focus on nursing science and
theory development
 Doctoral education began to
flourish.
 BATEY (1977) :conceptualization
is the greatest limitation of
nursing research; theory is a set
of related concepts; therefore
substantive research is essential
 Shift of emphasis from research
to theory
Theory Era (1980-1990s)
 Emphasis: nursing theory
development (cornerstone of
nursing)
 Focus: proliferation of nursing
literature and new nursing
journals, national and
international nursing
conferences, and opening of new
nursing doctoral program
 Scientific process for production
of scientific product is discovered
Theory Utilization Era (21st century)
 Emphasis: utilization of
philosophies, models or theories
in practice (theory based nursing
practice)
 Focus: from theory development
to theory application and
utilization using critical thinking
and decision making in nursing
practice
 Critical thinking is the
intellectually disciplined process
of actively and skillfully
conceptualizing, analyzing, and
evaluating information gathered
from observation, experience or
reflection as a guide to belief and
action.
Significance of Nursing Theory
 Discipline vs Profession
- The accomplishments of the past
century led to the recognition of
nursing both as an academic
discipline and a profession.
 Discipline- academe specific;
branch of education, department
of learning or domain of
knowledge
 Profession- practice specific;
specialized field founded on the
theoretical structure of the
science or knowledge of the
discipline and accompanying
practice abilities
Significance of Nursing Theory to
Profession
 Nursing is recognized as a
profession today because its
development was guided by the
criteria for a profession
  The commitment to theory-based
evidence for practice is beneficial
to patients in that it guides a
systematic and knowledgeable
care.
 Because theory amplifies
knowledge development, this
serves as a tool for reasoning,
critical thinking and decision
making in quality nursing
practice.
Lesson 2: History and philosophy of
science
SCIENCE
• describes, explains and predicts cause
of outcomes of interventions
• desires to know the unknown and
make a significant difference to increase
life longevity
SCIENTIFIC DISCIPLINE
• Identifies nursing’s unique knowledge
for patient, family and community care
• Nurses can conduct clinical and basic
nursing research to establish scientific
base for these care
TWO PHILOSOPHICAL
PERSPECTIVES USED IN SCIENCE:
1. Rationalism
2. Empiricism
Rationalism
 Reason is the chief source and
test of knowledge or justification
 Criterion of truth is not sensory,
but intellectual and deductive
(reasoning from cause and effect;
from general to particular)
 Example problem: Reason that
lack of social support (cause)
results in hospital readmission
(effect)
- The causal reasoning is still an
assertion until tested and
disproven. Hospitalization will be
explained first, data gathered
through deductive method will be
subjected to experimental testing
to corroborate the theory.
 Theory then research strategy. If
research findings fail to validate
the assertions, then additional
research for modifications are
made.
 Albert Einstein- a theoretical
physicist who made his rationalist
view by extensively using
mathematical equation in
developing his theories which
directed research in numerous
areas
EMPIRICISM
 Sensory experience is the source
of knowledge
 inductive (from data gathering to
generalizations ); collection of
facts precedes formulation of
generalizations
 Example problem: formulating
differential diagnosis from data
gathering then devising a list of
theories to explain the facts
 Research then theory strategy*
 Weakness: The world presents
an infinite number of possible
 observations; and therefore,
scientists become subjective in
bringing their own ideas from
their experiences to decide what
POSITIVISM
to observe and what to
exclude-----PREMATURE
CONCLUSION. Therefore, it is
important not to end the
observations too soon.
Rationalism
 Reason is the source of all
knowledge
 Mind contains innate ideas
Emergent Views of Science and
 Math is a model for knowledge
Theory in the late 20th Century
 Knowledge can be gained a priori
(deductive logic)
 Knowledge can be certain
 Senses are easily fooled
 Uses theory-then-research
strategy -TTRS
Empiricism
 The senses are the source of all
knowledge
 Mind is a “tabular rasa” (or “clean
slate”)
 Biology is a model for knowledge
 Knowledge is only gained a
posteriori (inductive method)
 Knowledge can ever be probable
 Reasons only can give us access
to uninformative tautologies
 Uses research-then-theory
strategy -RTTS
Early 20th Century Views of Science
and Theory
 Philosophers- theory structure;
 Scientists- empirical research
 Observation and experimentation
must be used to test theoretical
propositions
 Empirical research and logical
analysis (deductive and
inductive) are two approaches
that would produce scientific
knowledge.
 Theoretical propositions must be
tested through observation and
experimentation
 Empirical knowledge is arranged
in different patterns at a given
time and in a given culture and
that humans are emerging as
objects of study
 Science is a continuous process
of building research rather than a
product of findings.
 Observations are concept laden;
influenced by the values and
ideas in the observer’s mind.
Concepts and theories set up
boundaries and specify pertinent
phenomena for reasoning about
specific observed patterns.
 Theories play a significant role in
determining what the scientist
observes and how it is
interpreted.
 “ An elderly patient has been in
trauma and appears to be crying.
The nurse on admission
observes that the patient has
marks on her body and believes
that she has been abused; the
orthopedist has viewed an X-ray
 and believes that the crying
patient is in pain due to a
fractured femur that will not
require surgery, only a closed
reduction; the chaplain observes
the patient crying and believes
that patient needs spiritual
support. Each observation is a
concept laden.”
 Brown (1977) presented the
example of a chemist and a child
walking together past a steel mill.
The chemist perceived the odor
of sulfur dioxide and the child
smelled rotten eggs. Both
observers in the examples
responded to the same
observations but with distinctly
different interpretations.
History and Philosophy of Science
 Rationalism- This can be
described as the theory-then-
research approach . Because the
theory comes first, this approach
to knowledge development can
also be called deductive or a
priori reasoning.
 Empiricism- is a philosophy of
science which believes that
knowledge is derived entirely
from sensory experience.
Empiricism can be described as
the research-then- theory
approach. In essence, theorists
experience a phenomenon
through their senses, and they
identify concepts and
propositions that attempt to
explain what they perceive.
 Early twentieth Century views-
During the first half of this
century, philosophers focused on
the analysis of theory structure,
whereas scientists focused on
empirical research. Positivism, a
term first used by Comte,
emerged as the dominant view of
modern science. Modern logical
positivists believed that empirical
research and logical analysis
(deductive and inductive) were
two approaches that would
produce scientific knowledge.
 Emergent views of science and
theory in the late twentieth
century- published his analysis
of the epistemology (knowledge)
of human sciences from the
seventeenth to the nineteenth
century. His major thesis stated
that empirical knowledge was
arranged in different patterns at a
given time and in a given culture
and that humans where emerging
as objects of study. In The
Phenomenology of the Social
World, Schutz argued that
scientists seeking to understand
the social world could not
cognitively know an external
world that is independent of their
own life experiences. A
phenomenological approach
reduces observations or text to
the meanings of phenomena
independent of their context. This
approach focuses on the lived
meaning of experiences
CHAPTER 3: Structure of Nursing
Knowledge
Structure of Theory Development
 Theory development or theory
building is a process that
 primarily follows logical reasoning
involving induction, deduction
and retroduction
 Induction- This process moves
from specific to general
reasoning. Particular events are
observed and analyzed as basis
for formulating general theoretical
statements often called
“grounded theory” or research-to-
theory approach
Example: Mara, Clara, and Juday are
senior staff nurses
They have been observed as competent
Conclusion: All senior staff nurses are
competent
 Deduction- This process moves
from general to specific
reasoning. It establishes truth by
theoretical derivation having two
or more relational statements
used to explain a phenomenon.
Abstract theoretical relationships
are used to derive specific
empirical hypothesis.; theory-to-
research approach
Example: All senior nurses are
competent.
Michelle and Michael are senior staff
nurses
Conclusion: Michelle and Michael are
competent
 Retroduction- This combines
both induction and deduction.
The origin of idea which does not
establish truth but suggest lines
of thought worthy of exploration
and testing.
Example: The role of care and comfort
determines relation between nurse and
patient which establishes an influence of
the nurse caring attitude to patient.
Metaparadigm of nursing
 The components of nursing are
described in a metaparadigm
 Nursing has a model or paradigm
that explains the linkages of
science, philosophy, and theory
that is accepted and applied by
discipline.
 A metaparadigm is the global
perspective of a discipline that
identifies the primary phenomena
of interest to that discipline and
explains how the discipline deals
with those phenomena in a
unique manner.
 It assists in the articulation and
refinement of the nursing
phenomenon being explored.
 Nursing metaparadigm directs
the activity of the nursing
profession
METAPARADIGM
 Most global perspective of a
discipline; states the relations
between or among the concepts
METAPARADIGM OF NURSING
DESCRIBE CONCEPTS OF:
 PERSON (Recipient(s) of care)
 ENVIRONMENT (Internal and
External factors)
 HEALTH (Defined by Person)
 NURSING (Nursing actions)
  P.E.H.N.  G.,V and B., L. and R.

 Person- Human being or person:

individuals, families,communities,
and other groups who are
 Health- Human process of
participants in nursing. (Udan,
living and dying (Udan, 2020)
2020)
- degree of wellbeing or wellness
 Health- Human process of living
that a client experience
and dying. (Udan, 2020)
- includes promote care, comfort
 Environment- Human beings
like healthy lifestyle
significant others and physical
 Environment- Human beings
surroundings as well as local,
significant others and physical
regional, national and worldwide,
surroundings that are
cultural, social, political, and
associated with persons
economic conditions that are
health (Udan, 2020)
associated with person9s health.
 Nursing- actions taken by the
(Udan, 2020)
nurses on behalf or in
 Nursing- The actions taken by
conjunction with persons, and
the nurses on behalf or in
the goals of nursing actions
conjunction with persons, and the
- Nurses attribute like the ultimate
goals of nursing actions; the
goal of nursing is to IMPROVE
process of which encompasses
PATIENT CARE
activities that are referred to as
assessment, diagnosis (labeling), PHILOSOPHIES OF NURSING
planning, intervention and
• Theoretical works that address one or
evaluation
more metaparadigm concepts; answers
NURSING METAPARADIGM questions like:
 Model that explains the linkages • What is nursing?
of science, philosophy, and
• What is the nature of human caring?
theory.
 Person- human being or person: • What is the nature of nursing practice?
individuals, families,
• What is the social purpose of nursing
communities, and other groups
practice?
who are participants in nursing,
(is the recipient if the nursing CONCEPTUAL MODELS OF
care, main focal point of nursing) NURSING (Paradigm or framework)
 Take in consideration when
• Conceptual models of nursing identify
providing care:
abstract concepts and describe their
- gender,
relationships to the phenomena of
- values and belief,
central concern to the discipline; not
- lifestyle and religion
limited to a particular type of patient or
situation
• Provide framework for recording effect
of nursing
• The primary distinction between a
conceptual model and theory is their
level of abstraction.
• The primary distinction between a
conceptual model and theory is their
level of abstraction.
NURSING THEORIES (Paradigm or
framework)
• More specific than a conceptual model
• Conceptualization of reality that
pertains to nursing to describe, explain,
predict or prescribe nursing care
Nursing Philosophy
Nursing Philosophy- Set forth the
general meaning of nursing and nursing
phenomena through reasoning and the
logical presentation of ideas.
Philosophies are broad and address
general ideas about nursing. Because of
the breadth, nursing philosophies
contribute to the discipline by providing
directions, clarifying values and forming
foundation for theory development.
Classification of Nursing Theory
Based on Scope
 philosophical (world view) or
metatheory
 grand theory
 middle range theory
 practice theory
 M.GT.MRT.PT.
LEVEL OF NURSING THEORY BASED
ON SCOPE or LEVEL OF
ABSTRACTION
Levels of Nursing Theory
1. Philosophical (world view) or
metatheory
2. Grand theory- broad scope and
highly abstract
3. Middle range theory-fewer concepts
and propositions; limited nursing view,
for empirical testing and practice
4. Practice theory- most detailed,
concrete and specific
META THEORY
a. Theories whose subject matters are
some other theories
i. Ex: Nursing Philosophies
b. Highest level of theory in complexity
c. Very difficult for practical application
i. Metatheory of Transcendence in 2002
by Wilkins integration of the disciplines
of nursing and psychology and
exhibiting a multidisciplinary relevance
GRAND THEORY
a. Consists of conceptual frameworks
defining broad perspectives for nursing
practice
i. Nursing Conceptual Models
b. Lacks operational definition
i. Sr. Callista Roys Adaptation Model
ii. Orems Self Care Theory
iii. Nightingales Environmental Theory
MIDDLE RANGE THEORY
a. Contains limited numbers of concepts
and are limited in scope
b. Highly specific in nursing
c. Easier to apply as framework for
research studies
i. Benners Stages of Nursing
Expertise
1. Novice- Start of career
2. Advance Beginner- may experience
3. Expert- 50 years in service
ii. Leininger Culture Diversity Theory
ii. Theory of Comfort by Katherine
Kolcaba
PRACTICE THEORY
a. Situation specific theories
b. The least complex and action oriented
c. Limited to specific populations or field
of practice
i. Ex: Pain management in post op
patients
ii. Postpartum depression
iii. Klaus and Kennel maternal and
infant bonding theory
Classification of Theories Based on
Purpose/Functions
 factor-isolating theories-FIT
(descriptive theories) -DT
 factor-relating theories-FRT
(explanatory theories)-ET
 situation-relating theories-SRT
(predictive theories)-PDT
 situation-producing theories- SPT
(prescriptive theories)-PST
TYPES OF NURSING THEORY BASED
ON FUNCTION
• DESCRIPTIVE THEORIES
- They describe, observe, and
name concepts and properties
but they do not explain
interrelationships among
concepts.
- First and most important level of
theory development
- Example: literature review,
phenomenology, case
study/demographic study,
ethnography
EXPLANATORY THEORY
- Explains how or why concepts
are related
- Can be viewed in relation to other
phenomena
- Second level of theory
development
- Developed by correctional
research
- Example: theory of spirituality-
based Nursing practice by Nardi
& Rodha
PREDICTIVE THEORY
- describes precise relationships
between concepts
- predicts occurrence of a
phenomenon
- third level of theory development
- describes future outcomes
consistently
PRESCRIPTIVE THEORY
- highest level of theory
development
 - addresses nursing therapeutics
and consequences of
interventions to
- prevent occurrence of a
phenomenon
- prescribes activities necessary to
control possible causes
- example: Opo
Analysis and Evaluation of
Theoretical Knowledge in Nursing
A. ANALYSIS
Criteria for analysis of nursing
conceptual models and theories:
1. CLARITY- consistency in terms and
structure; diagrams and examples are
used
2. SIMPLICITY- sufficiently
comprehensive to provide guidance and
clarity; few concepts as possible
3. GENERALITY- scope of concepts
and purpose of theory is reflected well
4. ACCESSIBILITY- empirical precision;
empiric indicators for concepts can be
identified; to what extent the purpose of
the theory can be tested is presented
5. IMPORTANCE- derivable
consequences; should lead to further
research and knowledge of nursing
practice and other service profession
 C. S. G. A. I.
B. EVALUATION
Criteria:
• with values and philosophical claims of
the theorist
• comprehensive; depth and breadth are
ascertain (metaparadigm of nursing are
included)
• logical, and leads to another theory
generation
• with social utility- is special education
required to use the model in practice
• with social congruence- the model will
lead to nursing activities that meet the
expectations of the public
• with social significance- the model
makes differences in the health
conditions of the public
CHAPTER 4:Nightingale’s
Environmental Theory
 Nursing philosophy has been
described as “a statement of
foundational and universal
assumptions, beliefs and
principles about the nature of
knowledge and thought and
about the nature of the entities
represented in the metaparadigm
(i.e., nursing practice and human
health processes. It refers to the
belief system or worldview of the
profession and provides
perspectives for practice,
scholarship, and research. No
single dominant philosophy has
prevailed in the discipline of
nursing
“IN A NURTURING ENVIRONMENT,
THE BODY COULD REPAIR
ITSELF. “- NIGHTINGALE, 1800

FLORENCE NIGHTINGALE
BACKGROUND OF THE THEORIST
 Born in May 12, 1820 in
Florence Italy; from a wealthy
Victorian family
 Education -Privately educated
in the classical tradition of her
time by her father, and from an
early age, she was inclined to
care for the sick and injured.
Although her mother wished her
to lead a life of social grace,
Nightingale preferred productivity
(reading, embroidery, music),
choosing to school herself in the
care of the sick.
 At age 24, she decided to help
the suffering masses and desired
for hospital work. Though initially
opposed by her family and the
society, she attended nursing
programs in Kaisersworth,
Germany in 1850 and 1851 at
Institution of Deaconesses,
where she completed what was
at that time the only formal
nursing education available. She
studied for 3 months then went
back to the service of her
family.
 Work: After 2 years, in 1853
when she received her father’s
endowment, she moved to
London and she became the
Superintendent of the Hospital
for Invalid Gentlewomen; where
she instituted many changes to
improve patient care. Rather than
giving new nursing knowledge,
she reforms hospital
environments.
• Crimean War –Along with 38 nurses,
they travelled to Turkey to assist in
providing care for wounded soldiers
where they were faced with
overcrowded barracks and atrocious
sanitary conditions.
• Despite daunting opposition by army
physicians, Nightingale instituted a
system of care that reportedly cut
casualties from 48% to 2% within
approximately 2 years. Nightingale
found out that more than the wounds,
the causes of soldiers’ morbidity were:
• open sewers
• lack of cleanliness, pure water,
fresh air, and wholesome food
• She focused her efforts on organizing
nursing services and eliminating
sanitation problems in the hospital.
• She became known as the “Lady with
the Lamp” from her nightly
excursions through the wards to review
the care of the soldiers.
• To prove the value of the work she and
the nurses were doing, Nightingale
instituted a system of record keeping
and adapted a statistical reporting
method known as the Polar Area
Diagram, or Cock’s Comb Model, to
analyze the data she so rigorously
collected. Thus, Nightingale was the
first nurse to collect and analyze
evidence that her methods were
working.
• When she returned home, she
eventually began the Nightingale
School of Nursing at St. Thomas
which marked the beginning of
professional nursing.
• “Founder of Modern Nursing”-
because of her intense work in
reforming nursing.
NIGHTINGALE’S 12 CANONS
CENTRAL TO THE ENVIRONMENT
MODEL OF NURSING
• Nightingale believed that when one or
more aspects of the environment are out
of balance, the client must use
increased energy to counter the
environment stress. Those stresses
drain the client of energy needed for
healing.
1. HEALTH OF HOUSES
• Pure air, pure water, efficient drainage,
cleanliness, light
• “Badly constructed houses do for the
healthy what badly constructed hospitals
do for the sick. Once air is stagnant,
sickness is certain to follow.”
2. VENTILATION AND WARMING
• “Keep the air he breathes as pure as
the external air, without chilling him.”
(room temperature)
• The person who repeatedly breathed
his or her own air would be sick or
remain sick.
• Noxious air/ “effluvia”- foul odors that
affect client’s health (bedpans, urinals,
sewage, ditches)
• She criticized “fumigations” as she
believed that it is the offensive source
that must be removed and not the
smell.
3. LIGHT
• “Light has quite real and tangible
effects on human body” (sunlight- direct
or from window; adequate light)
• Sick rarely faces the wall, they are
much more likely to face the window,
where the sun is.
• “intensive care psychosis”- confusion
experienced in isolation rooms like ICU,
NICU, PACU, CCU Units – lack of usual
cycling of day and night
4. NOISE
• Keep noise in general to a minimum
(TV’s, mobile phones, alarm of machine,
nurses’ jewelries, jingling keys, snap of
rubber gloves, bed rails, etc.) as they
are irritating to patient
• Never wake patients intentionally or
accidentally during the first part of sleep
• Whispered or long conversations are
thoughtless and cruel; patient might
assume that the conversation is about
him
5. VARIETY
• Variety in patient’s room to avoid
boredom and depression (brightly
colored plants/ flowers); rotating painting
and engravings once in a while
• “Mind greatly affects the body”
• Offer activities like reading, needle
work, writing, cleaning to relieve
boredom of the sick
6. BED AND BEDDING
• Beddings should be changed and air
dried frequently. Patients exhale
moisture which enters the sheet and
stay there.
• Bed must be positioned in the lightest
part of the room where patient could see
out of the window
• Caregivers should not lean against, sit
upon or unnecessarily shake patient’s
bed.
7. CLEANLINESS OF ROOMS AND
WALLS
• “Greater part of nursing consists in
preserving cleanliness”
• Damp cloth over feather duster; avoid
dust trapping carpets; furniture should
be washed and not in contact with
moisture
• Clean room is a healthy room
8. PERSONAL CLEANLINESS
• Skin function is important. Unwashed
patient skin poisoned him; bathing and
drying can provide relief to the patient
• “Keep the pores of the skin free from
all obstructing excretions”
• “Every nurse should wash her hands
very frequently during the day”
9. NUTRITION AND TAKING FOOD
• Offer variety of food to patient.
Individuals desire different foods at
different part of the day. Small frequent
meal servings is more beneficial than
large breakfast or dinner
• Right food be brought at the right time,
and be taken away, eaten or uneaten at
the right time
• No business while the patient is eating
to avoid distraction
10. CHATTERING HOPES AND
ADVICES
• Falsely cheering the sick by making
light of their illness and its danger is not
helpful. (False hope)
• Avoid opinions after brief observation;
base everything on facts especially
when giving advice
• Good news from families, visitors is
encouraged to assist patients in
becoming healthier
11. OBSERVATION OF THE SICK
• “The most important practical lesson
that can be given to nurses is to teach
them what to observe. If you cannot get
the habit of observation one way or
another, you had better give up being a
nurse for it is not your calling, however
kind and anxious you maybe.”
• Always obtain complete and accurate
information about patients
• Make specific, precise and
individualized questions and
observations
12. PETTY MANAGEMENT
• “What you do when you are there,
shall be done when you are not there.”
• Continuity of care even in the absence
of nurse
• House and hospital should be well 13. Observation of the sick
managed- organized, clean and with
appropriate supplies  VW. L. CRW. HH. N. BB. PC. V.
CHA. TF. WF. PM. OS.
 VW. L. CRW. HH. N. BB. PC. V.
CHA. NTF. PM. OS.
THE NURSING PROCESS AND
NIGHTINGALE’S ENVIRONMENTAL
MODEL OF NURSING
1. Assessment and Planning
- Questioning about patient
preferences
- Observation focused on effects of MAJOR ASSUMPTIONS
environment on the patient 1. Environment
2. Nursing Diagnoses 2. Person
3. Outcomes and Planning 3. Health
4. Implementation 4. Nursing
- Manipulation of environmental
factors  E.P.H.N
5. Evaluation
- Documentation of observed CRITIQUE: NIGHTINGALE’S
effects of changes in ENVIRONMENTAL THEORY
environmental factors on patient’s 1. Clarity
health 2. Simplicity
3. Generality
 AP. ND. OP. I. E. 4. Empirical Precision
CRITICAL THINKING WITH (Accessibility)
NIGHTINGALE’S THEORY 5. Derivable Consequences
(Importance)
Nightingale’s 13 Canons A. Nursing the Sick
1. Ventilation and warmth - Assessment
2. Light - Plan
3. Cleanliness of rooms and walls B. Physical environment
4. Health of houses - Home, Community/Neighborhood
5. Noise and Workplace Assessment
6. Bed and bedding - Home, Community/Neighborhood
7. Personal cleanliness and Workplace Plan
8. Variety C. Psychological Environment
9. Chattering hopes and advices - Assessment and Plan
10. Taking food D. Nutrition
11. What food - Assessment and Plan
12. Petty management
 • Recipient of several honors and
awards including Fetzer Institute
Norman Cousins Award; an
International Kellogg fellowship in
Australia; a Fulbright Research Award in
Sweden; and 10
Honorary Doctoral Degrees, including
those from Sweden, United kingdom,
Spain, British Columbia

THEORY ON HUMAN CARING and Quebec in Canada, and from

Japan.
“THE FACT REMAINS THAT WE HOLD
ANOTHER’S LIFE IN • 1979- Nursing: The Philosophy And
Science Of Caring
OUR HANDS.”- WATSON, 2005
• 1988- Nursing: Human Science And
“WE ARE THE LIGHT IN Human Care
INSTITUTIONAL DARKNESS, AND IN
• WATSON’S PHILOSOPHY OF
THIS MODEL WE GET TO RETURN TO HUMAN CARING
THE LIGHT OF OUR
• “NURSING IS BOTH HUMAN
HUMANITY”- WATSON, 2012 SCIENCE AND AN ART, AND AS SUCH
JEAN WATSON CANNOT BE CONSIDERED
QUALITATIVELY
• BACKGROUND OF THE THEORIST
CONTINUOUS WITH TRADITIONAL,
• Born in 1940 in West Virginia REDUCTIONIST, SCIENTIFIC
• Education –finished BSN, MSN and METHODOLOGY.”
PhD degree at University of Colorado • Major elements:
• Work: Nursing Professor and Chair in • Carative factors-guide for nursing core
Caring in Caring Science at School of (in contrast with medicine’s conventional
Nursing at University of curative
Colorado Health Sciences Center then factors)
became Dean and President of National
League for Nursing • “caring with love”

• Internationally published author, having • from “caritas” which means to cherish,

written many books, book chapters, and appreciate and give special attention
articles about • Transpersonal caring relationship-
the science of human caring foundation of her theory; 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 goal: to facilitate individual in
gaining a higher degree of harmony
within the mind-body-spirit;
such harmony generates self-
knowledge, self-reverence, self-healing
and self-care processes through
human to human caring process and
caring transactions
• 10 CARITAS PROCESSES
• Evolved from the 10 carative factors;
includes spiritual dimension and overt
evocation of love and caring
• “Caritas consciousness”- awareness
and intentionality that forms the
foundation of a caritas nurse
1.
Practice of loving kindness and
equanimity of oneself and other within
context of caritas consciousness
-Develops at an early age with values
shared with parents
- Mediated through one’s own life
experiences; from exposure to
humanities
- Necessary to nurses’ own maturation
which promotes altruistic behavior
2.
Being authentically present, enabling,
sustaining, and honoring the faith, hope,
and deep belief system and
the inner-subjective world of self/ other.
-When modern science has nothing
further to offer the person, the nurse can
continue to use faithhope to provide a
sense of well-being through beliefs
which are meaningful to the individual.
3.
Cultivating one’s own spiritual practices
and transpersonal self, going beyond
ego self; opening to others
with sensitivity and compassion
- Development of one’s own feeling to
interact genuinely and sensitively with
others
-Strive to become sensitive, authentic to
promote self-growth and self-
actualization as a nurse and to
whom she interacts
4. Developing and sustaining a helping-
trusting, authentic caring relationship
-Communication is the strongest tool
which establishes rapport and caring
(verbal, non-verbal
listening for empathetic understanding)
-Three characteristics needed for
helping trusting relationship
(Congruence, Empathy and Warmth)
5. Being present to, and supportive of
the expression of positive and negative
feelings to connect with deeper
spirit of oneself and the one being cared
for
- “feelings alter thoughts and behaviour;
therefore needed to be considered and
allowed for in a
caring relationship---- this improves self essentials,’ which potentiate alignment
awareness which allow understanding of mind-body-spirit, wholeness in all
the behaviour of others aspects of care, tending to
6. . Creative use of self and all ways of both the embodied spirit and evolving
knowing as part of the caring process to spiritual emergence.
engage in artistry of caringhealing
-Grounded from Maslow’s hierarchy of
practices/ caritas.
needs; where she created a hierarchy
-Scientific problem solving method is relevant to caring
the only method that allows for control
in nursing
and prediction; and
- Each need is equally important for
permits self correction
optimal health; all needs deserve to be
- Caring should not always be neutral attended and
and objective
valued
7. Engaging in genuine teaching-
- Each psychological function has a
learning experience that attends to
physiological correlate and vice- versa
wholeness and meaning, attempting to
- Example: Bulimia, anorexia and other
stay within other’s frame of reference.
gastro-intestinal disorders indicate a
-Learning process is as important as the complex
teaching process for the nurse to
interaction between the physiological
prepare a cognitive plan
and psychological correlates
8. Creating healing environment at all
MASLOW’S HIERARCHY OF NEEDS
levels, subtle environment of energy and
consciousness, whereby 1. Self-Actualization
2. Esteem
wholeness, beauty, comfort, dignity, and
3. Love/Belonging
peace are potentiated.
4. Safety
-Nurse must manipulate the internal and 5. Physiological
external variables (environment) to
10. Opening and attending to spiritual-
provide support
mysterious and existential dimensions of
and protection of patient’s mental and one’s life-death; soul
physical well-being
care for self and the one-being-cared for
- Nurse must provide comfort, privacy
- Phenomenology is a way of
and safety
understanding people from the way
9. Assisting with basic needs, with an things appear to them, for
intentional caring consciousness,
their frame of reference
administering ‘human care
 - “Our rational minds and modern was in high school, which she
science do not have all the answers to described as a difficult event for
life and death and all her entire family. She married
Richard Benner in 1967 and they
the human conditions we face. Thus we
had two children.
have to open to unknowns we cannot
 Education -She earned a
control, even allowing for
bachelor's degree from Pasadena
“miracle” to enter our life and work.” College in 1964. She earned a
Master's Degree in Nursing in
-Nurse assists the person to find the
1970 and a PhD in 1982 from the
strength or courage to confront life and
University of California, San
death
Francisco.
Nursing Process  Work: Benner decided to become
a nurse while working in a
6. Assessment
hospital admitting department
7. Planning
during college. She has been a
8. Implementation
staff nurse in MS Ward, ER,
9. Evaluation
CCU, ICU. She is an
LESSON 3 STAGES OF NURSING internationally noted researcher
EXPERTISE and lecturer.
 Benner is known for one of her
“EFFECTIVE DELIVERY OF PATIENT/
nine books, From Novice to
FAMILY CARE REQUIRES
Expert: Excellence and Power in
COLLECTIVE ATTENTIVENESS AND
Clinical Nursing Practice (1984).
MUTUAL SUPPORT OF GOOD
 She described the stages of
PRACTICE EMBEDDED IN A
learning and skill acquisition
MORAL COMMUNITY OF
across the careers of nurses,
PRACTITIONERS…HOWEVER,
applying the Dreyfus Model of
SUCH ENDEAVORS MUST BE
Skill Acquisition (chess master
COMPRISED OF INDIVIDUAL
and airline pilots) to nursing
PRACTITIONERS WHO HAVE
practice. She is a professor
SKILLED KNOW HOW, CRAFT,
Emerita at the UCSF, College of
SCIENCE AND MORAL IMAGINATION
Nursing
TO CREATE AND INSTANTIATE
 Benner was named a Living
GOOD PRACTICE. “- BENNER, 1999
Legend of the American Academy
PATRICIA BENNER of Nursing in 2011. The Living
Legends designation honors
Background of the theorist
individuals with "extraordinary
 Born as Patricia Sawyer in contributions to the nursing
August 1942 in Hampton, profession, sustained over the
Virginia. They moved to California course of their careers
when she was a child; then her
Philosophical Sources
parents were divorced when she
  Benner believes that knowledge
accrues over time in a practice
discipline and that articulation
research is necessary; which she
defines as describing, illustrating
and giving language to taken-for-
granted areas of practical
wisdom, skilled know-how, and
notions of good practice.
 One of her first philosophical
distinctions is differentiating
between practical and theoretical
knowledge. Practical knowledge
(know-how) which may elude
precise abstract formulation;
theoretical knowledge (know-that)
which results to theoretical
formulations. “Theory is derived
from practice, and practice is
extended by theory.”
 “Experience based skill
acquisition is safer and quicker
when it rests upon a sound
educational base.
5 Stages of Nursing Practice
1. NOVICE
 Person has no background
experience of the situation in
which he or she is involved;
 context free rules and objective
attributes are necessary
 There is difficulty discerning
between relevant and irrelevant
aspects of a situation
 Nursing student level; nurses
transferring to new area/
department which is completely
foreign to them
2. ADVANCED BEGINNER
 Person can demonstrate
marginally acceptable
performance; guided by a
mentor; has enough experience
to grasp aspect of the situation,
but not in a larger perspective
 Clinical situations are viewed as
test of their abilities and demands
of the situation rather than in
terms of patient needs and
responses
 Rule guided; task completion
oriented
 Advanced beginners feel highly
responsible for managing patient
care, yet still rely on the help of
those who are more experienced
 Graduate nurses level
3. COMPETENT
 Conscious and deliberate
planning that determines the
aspects of current and future
situations that are important and
can be ignored
 Consistency, predictability, time
management are important in
competent performance
 With sense of mastery through
planning and predictability; with
hyper-responsibility of the patient
which is realistic, and may exhibit
an ever-present and critical view
of self
 The level of efficiency is
increased, but the focus is on
time management and the
organization of the task rather
than on timing in relation to
patient’s needs
  Active teaching and learning is
important for stage transition
 This is the most pivotal in clinical
learning because the learner
begins to recognize patterns and
determine which elements of the
situation warrant attention and
which can be ignored. He can
devise new rules and procedures
for a plan.
 Emotional responses
(exhilaration and remorse) are
formative stages of esthetic
appreciation/ moral compass of
good practice
4. PROFICIENT
 Person perceives the situation as
a whole rather than in terms of
aspects; performance is guided
by maxims
 Knows the salient aspect and has
an intuitive grasp of the situation
based on background
understanding
 Uses skilled responses; more
involved in patient and family
care, without relying on preset
organizational goals
 Demonstrates increased
confidence in their knowledge
and abilities
5. EXPERT
 Person no longer relies on
analytical principle (rule,
guideline, maxim) to connect an
understanding of the situation to
an appropriate action
 With an intuitive grasp of the
situation, able to identify problem
without losing time despite range
of alternative diagnosis and
solutions
 Knows the patient well as a
person with typical pattern of
responses; with almost a
transparent view of the self
 Meeting the patient’s actual
concerns and needs is of utmost
importance, even if it means
planning and negotiating a
change of care
 Key aspects:
- Demonstrating clinical grasp and
resource based practice
- Possessing embodied know how
- Seeing the big picture
- Seeing the unexpected
Benner’s Domain of Nursing Practice
1. The Helping Role Domain
 Establishing a healing relationship,
providing comfort measures, and inviting
patient participation and control in care
2. The Teaching- Coaching Function
Domain
Timing, readying patients for learning,
motivating, assisting with lifestyle
alterations and negotiating goal
agreement
3. The Diagnostic and Patient-
Monitoring Function
 Ongoing assessment and outcome
anticipation
4. The Effective Management of
Rapidly Changing Situations Domain
Contingently matching demands with
resources; crisis management care
5. The Administering and Monitoring
Therapeutic Interventions and
Regimen Domain
 Preventing complications during drug
therapy, wound management and
hospitalization
6. The Monitoring and Ensuring the
Quality of Healthcare Practices
Domain
Maintenance of safety, continuous
quality improvement, collaboration and
consultation with physicians and other
healthcare team
7. The Organizational and Work-Role
Eriksson’s Nursing Philosophy
Competencies Domain
 Priority setting, team building,
coordinating and providing for continuity
care
LESSON 4 THEORY OF CARITATIVE
CARING
“SUFFERING THAT OCCURS AS A
RESULT OF A LACK OF CARITATIVE
CARE IS A VIOLATION OF HUMAN
DIGNITY”–ERIKSSON, 1992
KATIE ERIKSSON
Background of the theorist
 Born 1943 in Jakobstad,
Finland, .
 Education - After taking nursing in
1965 at Helsinki Swedish School
of Nursing, she completed Public
Health Nursing in 19667 at the
same school.
 Work: 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.
 Under Eriksson’s leadership at
Helsinki Swedish School of
Nursing, she developed a leading
educational program in caring
science and nursing. She
integrated research in education.
Toward the end of the 1980,
nursing science became a
university subject in Finland.
 Caritas as an aspect of nursing
practice was introduced to recent
nursing literature in 1989 by Katie
Eriksson as the caritas motive, a
motive proposed to guide all
human caring in society at-large
and particularly in nursing.
Eriksson (1990) argues that
caritas is caring in its original
form; "caring which is based on
human love", having "a real
interest in doing something for
another person, by attending, in a
deep sense feeling responsible
for another person. It is human
love and mercy, it is willingness to
serve another person".
 Eriksson (1997) also describes
caritas as "a vaccine for the
weary, implying that nurses draw
on caritas for their own health
from a spiritual source within
themselves. Drawing on
philosophical sources and
practice experience, Eriksson
developed her work on caritas
 into the theory of caratative
caring (Lindstrom et al. (2018).
This theory has caritas as a
principle concept, an
understanding of caritas that is
similar to that of Careful Nursing.
 The word caritas became more
widely known in nursing in 2006
when it was adopted by Jean
Watson into her theory of human
caring, which evolved from her 10
caring factors in 1990.
ERIKSSON’S THEORY ON
CARITATIVE CARING
MAJOR CONCEPTS & DEFINITIONS
Caritas means love and charity.
In caritas, eros (PASSIONATE LOVE)
and agape (SELFLESS AND
UNCONDITIONAL, CHRIST-LIKE
LOVE) are united, and caritas is by
nature unconditional love. Caritas, which
is the fundamental motive of caring
science, also constitutes the motive for
all caring. It means that caring is an
endeavour to mediate faith, hope, and
love through tending, playing, and
learning.
Caring communion
Caring communion constitutes the
context of the meaning of caring and is
the structure that determines caring
reality. Caring gets its distinctive
character through caring communion
(Eriksson, 1990). It is a form of intimate
connection that characterizes caring.
Caring communion requires meeting in
time and space, an absolute, lasting
presence (Eriksson, 1992c). Caring
communion is characterized by intensity
and vitality, and by warmth, closeness,
rest, respect, honesty, and tolerance. It
cannot be taken for granted but pre-
supposes a conscious effort to be with
the other. Caring communion is seen as
the source of strength and meaning in
caring. Eriksson (1990) writes in Pro
Caritate, referring to Lévinas:
Entering into communion implies
creating opportunities for the other—to
be able to step out of the enclosure of
his/her own identity, out of that which
belongs to one towards that which does
not belong to one and is nevertheless
one’s own—it is one of the deepest
forms of communion (pp. 28–29).
Joining in a communion means creating
possibilities for the other. Lévinas
suggests that considering someone as
one’s own son implies a relationship
“beyond the possible” (1985, p. 71;
1988). In this relationship, the individual
perceives the other person’s possibilities
as if they were his or her own. This
requires the ability to move toward that
which is no longer one’s own but which
belongs to oneself. It is one of the
deepest forms of communion (Eriksson,
1992b). Caring communion is what
unites and ties together and gives caring
its significance (Eriksson, 1992a).
The Act of Caring
The act of caring contains the caring
elements (faith, hope, love, tending,
playing, and learning), involves the
categories of infinity and eternity, and
invites to deep communion. The act of
caring is the art of making something
very special out of something less
special.
Caritative Caring Ethics
Caritative caring ethics comprises the
ethics of caring, the core of which is
determined by the caritas motive.
Eriksson makes a distinction between
caring ethics and nursing ethics. She
also defines the foundations of ethics in
care and its essential substance. Caring
ethics deals with the basic relation
between the patient and the nurse—the
way in which the nurse meets the
patient in an ethical sense. It is about
the approach we have toward the
patient. Nursing ethics deals with the
ethical principles and rules that guide
ones work or decisions. Caring ethics is
the core of nursing ethics. The
foundations of caritative ethics can be
found not only in history, but also in the
dividing line between theological and
human ethics in general. Eriksson has
been influenced by Nygren’s (1966)
human ethics and Lévinas’ (1988) “face
ethics,” among others. Ethical caring is
what we actually make explicit through
our approach and the things we do for
the patient in practice. An approach that
is based on ethics in care means that
we, without prejudice, see the human
being with respect, and that we confirm
his or her absolute dignity. It also means
that we are willing to sacrifice something
of ourselves. The ethical categories that
emerge as basic in caritative caring
ethics are human dignity, the caring
communion, invitation, responsibility,
good and evil, and virtue and obligation.
In an ethical act, the good is brought out
through ethical actions (Eriksson, 1995,
2003).
Dignity
Dignity constitutes one of the basic
concepts of caritative caring ethics.
Human dignity is partly absolute dignity,
partly relative dignity. Absolute dignity is
granted the human being through
creation, while relative dignity is
influenced and formed through culture
and external contexts. A human being’s
absolute dignity involves the right to be
confirmed as a unique human being
(Eriksson, 1988, 1995, 1997a).
Invitation
Invitation refers to the act that occurs
when the carer welcomes the patient to
the caring communion. The concept of
invitation finds room for a place where
the human being is allowed to rest, a
place that breathes genuine hospitality,
and where the patient’s appeal for
charity meets with a response (Eriksson,
1995; Eriksson & Lindström, 2000).
Suffering
Suffering is an ontological concept
described as a human being’s struggle
between good and evil in a state of
becoming. Suffering implies in some
sense dying away from something, and
through reconciliation, the wholeness of
body, soul, and spirit is re-created, when
the human being’s holiness and dignity
appear. Suffering is a unique, isolated
total experience and is not synonymous
with pain (Eriksson, 1984, 1993).
Suffering related to illness, to care,
and to life
These are three different forms of
suffering. Suffering related to illness is
experienced in connection with illness
and treatment. When the patient is
exposed to suffering caused by care or
absence of caring, the patient
experiences suffering related to care,
which is always a violation of the
patient’s dignity. Not to be taken
seriously, not to be welcome, being
blamed, and being subjected to the
exercise of power are various forms of
suffering related to care. In the situation
of being a patient, the entire life of a
human being may be experienced as
suffering related to life (Eriksson, 1993,
1994a; Lindholm & Eriksson, 1993).
The suffering human being
The suffering human being is the
concept that Eriksson uses to describe
the patient. The patient refers to the
concept of patients (Latin), which means
“suffering.” The patient is a suffering
human being, or a human being who
suffers and patiently endures (Eriksson,
1994a; Eriksson & Herberts, 1992).
Reconciliation
Reconciliation refers to the drama of
suffering. A human being who suffers
wants to be confirmed in his or her
suffering and be given time and space to
suffer and reach reconciliation.
Reconciliation implies a change through
which a new wholeness is formed of the
life the human being has lost in
suffering. In reconciliation, the
importance of sacrifice emerges
(Eriksson, 1994a). Having achieved
reconciliation implies living with an
imperfection with regard to oneself and
others but seeing a way forward and a
meaning in one’s suffering.
Reconciliation is a prerequisite of caritas
(Eriksson, 1990).
Caring culture
Caring culture is the concept that
Eriksson (1987a) uses instead of
environment. It characterizes the total
caring reality and is based on cultural
elements such as traditions, rituals, and
basic values. Caring culture transmits
an inner order of value preferences or
ethos, and the different constructions of
culture have their basis in the changes
of value that ethos undergoes. If
communion arises based on the ethos,
the culture becomes inviting. Respect
for the human being, his or her dignity
and holiness, forms the goal of
communion and participation in a caring
culture. The origin of the concept of
culture is to be found in such
dimensions as reverence, tending,
cultivating, and caring; these
dimensions are central to the basic
motive of preserving and developing a
caring culture (Eriksson, 1987a;
Eriksson & Lindström, 2003).