TFN INTRODUCTION
NURSING PHILOSOPHY
 It as a “’statement of foundational and universal
assumptions, beliefs and principles about the
nature of knowledge and thought (epistemology)
and about the nature of entities represented in
metaparadigm (nursing practice and human health
processes.)” (Reed, 1995, p.76)
 Refers to the belief system or worldview of the
profession and provides perspective for practice,
scholarship and research.
NURSING SCIENCE
 It is the substantive, discipline- specific knowledge
that focuses on the human- universe health
process articulated in the nursing frameworks and
theories.
 To develop and apply the discipline- specific
knowledge, nursing science recognizes the
relationship of human responses in health
illnesses, biological, social, and cultural domains.
Philosophy of Science in Nursing
 It refers to the philosophical foundations and
principles that underpin the scientific inquiry and
practice of nursing. It encompasses the beliefs,
assumptions, and values that guide the
development of nursing knowledge, research, and
the delivery of patient care within a scientific
context.
 It helps to establish the meaning of science
through an understanding and examination of
nursing concepts, theories, laws and aims as theyt
relate to nursing practice.
 Development of nursing knowledge reflects the
interface between nursing science and research.
The ultimate purpose of knowledge development
is to improve nursing practice. Approaches to
knowledge development have three facets:
ontology, epistemology and methodology.
ONTOLOGY
 It is the study of being; what is or what exists.
 It is a branch of philosophy that deals with
questions about the nature of reality, existence,
and being. It explores the fundamental questions
about what exists, what can be said to exist, and
how things relate to one another.
EPISTEMOLOGY
 Refers to the study of knowledge or ways of
knowing.
Ways of Knowing:
 Empirics – scientific form of knowing.
 Personal Knowledge – a priori knowledge. Pertains
to knowledge gained from thought alone
 Intuitive Knowledge – includes feelings and
hunches
 Somatic Knowledge – knowledge of the body in
relation to physical movement
 Metaphysical (spiritual) knowledge – seeking the
presence of higher power
 Esthetic knowledge – knowledge related to
beauty, harmony, and expression
 Moral or Ethical Knowledge – knowledge of what
is right and wrong
METHODOLOGY
 The means of acquiring knowledge.
NURSING THEORY
THE IMPORTANCE OF NURSING THEORY
1. Identify certain standards for nursing practice.
2. Identify settings in which nursing practice should
occur and the characteristics of what the models
author considers recipients of nursing care.
3. Identify distinctive nursing processes and
technologies to be used, including parameters for
the client assessment, labels for client problems, a
strategy for planning, a typology of intervention,
and criteria for evaluation of intervention
outcomes.
4. Direct the delivery of nursing services.
5. Serve as the basis for clinical information system,
including admission database, nursing orders, care
plan, progress notes, and discharge summary.
6. Guide the development of client classification
systems.
7. Direct quality assurance programs.
Historical Overview: Theory Development in
Nursing
Florence Nightingale
 Known to be the lady on the Lamp
 The first modern nursing theorist
 the first to delineate and considered nursing goal
and practice domain, and ponstulated that "to
nurse”meant having charge of the personal health
of someone.
  She believed the role of the nurse was seen as Classification of Theories Based on Purpose
placing the client in the best condition for nature
1.Descriptive (Factor- Isolating) Theories
to act upon him (Hilton,1997)
- Those that describe, observe, and name
 She received her formal training in Nursing in
concepts, properties, and dimensions
1851, and renowned service for the British army
- Provide observation and meaning regarding
during the Crimean War and returned to London
the phenomena
and established a school of nurses.
2. Explanatory (Factor- Relating) Theories
 She was the first to advocate the teaching of
- Or explanatory theories
symptoms and what they indicate and taught the
- Those that relate concepts to one another,
importance of rationale for actions and stressed
describe the interrelationships among
the significance of trained powers of observations
concepts or propositions, and specify the
and reflection.
associations or relationships among some
NOTES ON NURSING concepts.
- They attempt to tell how and why the
 published in 1859 concepts are related.
 she proposed basic premises for nursing practice. 3. Predictive (Situation- Relating) Theories
 nurses were to make astute observations of the - Move to prediction of precise relationships
sick and their environment, record observations, between concepts
and develop knowledge about factors that 4. Prescriptive (Situation-Producing) Theories
promoted healing - Those that prescribe activities necessary to
reach defined goals.
6 Stages of Theory Development in Nursing
METAPARADIGM
1. Silent knowledge – blind obedience to medical
authority
2. Received knowledge – learning through listening
to others
3. Subjective knowledge – authority was internalized
to foster a new sense of self
4. Procedural knowledge – includes both separate
and connected knowledge
5. Constructed knowledge – combination of different
types of knowledge (intuition, reason, and self-
knowledge)
6. Integrated knowledge – assimilation and
application of “evidence” from nursing and other
health care discipline.
Classification of Theories Based on Level of Abstraction
 Person – refers to a being physical, intellectual,
1. Metatheory biochemical, and psychosocial needs; a human
- refers to a theory about theory. energy field; a holistic being in the world; an open
- focuses on broad issues system; an integrated whole; an adaptive system;
2. Grand Theories and a being who is greater than sum of his or her
- The most complex and broadest in scope. parts.
 Macro theory – used by some authors to describe  Health – the ability to function independently;
a theory successful adaptation to life’s stressors;
3. Middle Range Theories achievement of one’s full life potential; and unity
- Lies between the grand nursing models and of mind, body, and soul
more circumscribed, concrete ideas.  Environment – refers to the external elements that
- Substantively specific and encompass a limited affect the person
number of concepts and limited aspect of the  Nursing – is a science, an art, and a practice
real world discipline and involves caring.
4. Practice Theories CONCEPTSIN NURSING
- Also called as situation-specific theories, - Refer to phenomena that occur in nature or in
prescriptive theories, or microtheories, least thought.
complex
Types of Concepts
1. Enumerative concepts
- are always present and universal
- age, height, weight
2. Associative concepts
- Exist only in some conditions within a
phenomenon; may have a zero value
- Income, presence of disease, anxiety
3. Relational concepts
- Can be understood only through the
combination or interaction of two or more
enumerative or associative concepts
- Elderly (must combine concepts of age and
longevity, mother (must combine man,
woman, and birth)
4. Statistical concepts
- Relate the property of one thing in terms of its
distribution in the population rate
- Average of blood pressure, HIV/AIDS,
prevalence rate
5. Summative concepts
- Represent n entire complex entity of a
phenomenon; are complex and not
measurable
- nursing, health, and environment
Sources of Concept
1. Naturalistic concepts
- present in nursing practice
- may be defined and developed for use in
research and theory development often have
medical implications as well ad nursing use
- body weight, pain, thermoregulation,
depression, hematologic complications,
circadian dysregulation
2. Research-based concepts
- Developed through qualitative research
processes
- Often relate to a nursing specialty
- Hope, grief, cultural competence, chronic pain
3. Existing concepts
- Borrowed from disciplines
- Developed for nursing practice but are useful
in research and theory
- Job satisfaction, quality of life, abuse,
adaptation, stress
Purposes of Concept Development
1. Identifying gaps in nursing knowledge.
2. Determining the need to refine of clarify a concept
when it appears to have multiple meanings
3. Evaluating the adequacy of competing concepts in
their relation to other phenomena.
4. Examining the congruence between the definition
of the concept and the way it has been
operationalized.
5. Determining the it between the definition of the
concept and its clinical applications.
Walker and Avant
Three different processes were described :
Concept Analysis
- (2019) to clarify meanings of terms and to
define terms (concepts) so that writers and
readers share a common language.
Concept Synthesis
- Used when concepts required development
based on observation or other forms of
synthesis.
Concept Derivation
- It is applicable when a comparison or analogy
can be made between one field or area that is
conceptually defines and another that is not.
- Generating ways of thinking about
phenomenon or interest
Rogers Concept Process
 Collecting and managing data
 surrogate terms
 analyzing the data
 identifying the exempler
 interpreting the result
 Identifying implication
Schwarts- Barcott and Kim
 Theoretical Phase
- Borrowed concept
 Fieldwork Phase
- The concept is corroborated and refined
 Analtical Phase
- Final analytical phase includes examination of
the details in the light of the literature review
Meleis (2018)
 Concept Exploration
- Used when concepts are new and amigous in a
discipline
 Concept Clarification
- “ refine concepts that have been used in
nursing without a clear, shared, and conscious
agreement on the properties of meanings
attributed to them”
- Way to refine existing concepts when they lack
clarify for a specific nursing endeavor
 Concept Analysis
- Assumes that concept has been introduced
into nursing literature but is ready to move to
the level of development for research
Morse
 Concept Delineation
- Strategy that requires an extensive literature
search and assists in separating two terms that
are linked
 Concept Comparison
- Clarifies competing concepts, again using an
extensive literature review and keeping the
literature for each concept separate.
 Concept Clarification
- Used with concepts that are “mature”
Penrod and Hupcey (2005) - Raised in Welch, West Virginia in the
- “principle-based concept analysis” Appalachian Mountains
 Epistemologic principle - She was the youngest among of her 8 children
 Progmatic principle - Was surrounded by a large family environment
 Linguistic principle Douglas
 Logical principle - Husband of Jean Watson
THEORY DEVELOPMENT - After she graduated in 1961, they got married
RESEARCH THEORY PRACTICE - They moved from West to Colorado
Relationship among Theory, Research, Practice Educational Background
1. Theory and Research  Attended High School in Watson, West Virginia,
- Validated and modifies theory then Lewis and Gale School of Nursing in Roanoke,
2. Theory and Practice Virginia, from which she graduated 1961
- Theory guides practice 1964 – earned a Bachelor of Science in Nursing
3. Research and practice 1966 – Master of Science in Psychiatry and Mental Health
- It is the key to the development of a discipline Nursing and Ph.D.
STRATEGIES FOR THEORY DEVELOPMENT 1973 – PhD in Educational Psychology and Counseling
1. THEORY-PRACTICE-THEORY *All from the University of Colorado Boulder*
- Borrowed or shared theory BOOKS OF JEAN WATSON
- Not complete or not completely developed for  Nursing; The Philosophy and Science of Caring
nursing  Watson’s Clinical Nursing and Related Sciences
2. PRACTICE THEORY  Post-modern Nursing and Beyond
- Grounded theory  Caring Science as Sacred Science
- Theory is derived from clinical situations  Human Caring Science: A Theory of Nursing
3. RESEARCH THEORY ACHIEVEMENTS OF JEAN WATSON
- Scientific theory The Dean
- Development of theory is based on research - Of the School of Nursing at the University of
4. THEORY-RESEARCH-THEORY Colorado and founded and directed the Center
- Drives the research questions for Human Caring at the Health Sciences
Process of Theory Development Center in Denver
1. Concept Development Jean Watson
- Specifying, defining, and clarifying, the - received numerous awards and honors
concepts used to describe a phenomenon of - a distinguished professor of nursing and dean
interest emerita at the University of Colorado Denver
2. Statement Development College of Nursing and Anschutz Medical
- Formulating and analyzing statements Center
3. Theory Construction - endowed chair in Caring Science for 16 years
- Validating theories (Willis & Leone-Sheehan, 2018)
4. Application of theory in practice - fellow of the American Academy of Nursing
- Using research methods to assess how theory and
can be apply - past president of the National League for
THEORY ANALYSIS AND EVALUATION Nursing
1. Theory Description Her honor
- The works of a theorist are reviewed with a - Fetzer Institute Norman Cousins Award
focus on the historical context of the theory - International Kellogg Fellowship in Australia
2. Theory Analysis - a Fulbright research award in Sweden and
- It refers to a systematic process - 16 honorary doctoral degrees including those
3. Theory Evaluation from Sweden, UK, Spain, British Columbia and
- Follows analysis and assess the theory’s Quebec in Canada, Japan, Columbia and Peru
potential contribution to the discipline’s THEORY OF HUMAN CARING
knowledge. • It was developed “to convey a deeper human
JEAN WATSON involvement and connection”.
- June 10, 1940 – present • emphasizes the importance of caring in the nurse-
- “A living Legend in Nursing” – formally patient relationship and the healing process.
designated by the American Academy of • shaped the philosophy of nursing care,
Nursing encouraging nurses to view their patients as whole
- Knownfor her development of the “Theory of individuals with physical, emotional and spiritual
Human Caring” needs and approach their care in a holistic and
compassionate manner.
Several core concepts:
1. Transpersonal Caring
- This concept emphasizes the spiritual and
emotional connection between the nurse and
the patient. It goes beyond the physical
aspects of care
2. Caring Environment
- Watson believes that the physical and
emotional environment plays a crucial role in
the healing process. A supportive and nursing
environment is essential for patients to heal.
3. Caring Occasion/Caring Moment
- These are the actual interactions between the
nurse and the patient, where genuine care and
concern are expressed.
4. Carative Factors
- Watson identified ten carative factors that
should guide nursing practice, including
cultivating a helping-trust relationship,
expressing positive and negative feelings and
providing a supportive, protective, and/or
corrective mental, physical, societal and
spiritual environment.
10 CARATIVE PROCESSES
1. Sustaining humanistic-altruistic values by practice
of loving-kindness, compassion and equanimity
with self/others.
2. Being authentically present, enabling
faith/hope/belief system; honoring subjective
inner, life-world or self with others.
3. Being sensitive to self and others by cultivating
own spiritual practices; beyond ego-self to
transpersonal presence.
4. Developing and sustaining loving, trusting-caring
relationships.
5. Allowing for expression of positive and negative
feelings-authentically listening to another person’s
story.
6. Creatively problem-solving –”solution-seeking”
through caring process; full use of self and artistry
of caring-healing practices via use of all ways of
knowing/being/doing/becoming.
7. Engaging in transpersonal teaching and learning
within context of caring relationship; staying within
other’s frame of reference-shirt toward coaching
model for expanded health/wellness.
8. 8. Creating healing environment at all levels; subtle
environment for energetic authentic caring
presence.
9. 9. Reverentially assisting with basic needs as
sacred acts, touching mind-body-spirit of others;
sustaining human dignity.
10. 10. Opening to spiritual, mystery, unkown-allowing
for miracles.
Jean Watson’s Hierarchy of Need
ASSUMPTIONS OF THE THEORY
• Caring is a Moral Imperative.
• Caring is Central to Nursing.
• Caring occurs in Human-to-Human Connection.
• Caring Considers the Whole Person.
• Caring Enhances Well-Being.
• Caring requires Time and Presence.
• Caring Promotes Self-Growth in the Nurse.
• Caring is Transcultural and Transpersonal.
MAJOR CONCEPTS
1. HUMAN BEING - Watson views the human being
as a holistic, biophysical-spiritual being. She
emphasizes that patients are not just physical
bodies with health problems; they have emotional,
mental and spiritual dimensions that need to be
considered in their care.
2. HEALTH - In Watson’s theory, health is seen as
more than just the absence of illness. It’s a
dynamic process that involves the individual’s
ability to achieve a high level of physical, emotional
and spiritual well-being.
3. NURSING - According to Watson, nursing is a
human science and an art that focuses on the
promotion of health, the prevention of illness and
the provision of caring for individuals. It involves a
deep and meaningful nurse-patient relationship.
4. ENVIRONMENT - The concept of the environment
in the Theory of Human Caring extends beyond the
physical surroundings. It includes the emotional
and spiritual atmosphere, which can significantly
impact the patient’s healing process.
PATRICIA BENNER
 August 10, 1945, in Hampton, Virginia, USA.
1964 - Earned her Bachelor of Arts in Nursing from
Pasadena College
1970 - Master’s degree in medical Surgical Nursing from the
University of California
1982 - Completed her Doctorate in Education from the
University of California, Berkeley
 A nursing theorist known for her work in the field
of nursing education and practice
  She developed the “Novice to Expert”theory
NOVICE TO EXPERT THEORY
• Is a model that explains the process of skill
acquisition and development of expertise in
nursing practice.
 Benner's theory emphasizes that expertise is
gained through a combination of experiential
learning, reflection, and mentorship. It has been
instrumental in shaping nursing education and
guiding the development of nurses' clinical skills
and critical thinking abilities.
FIVE STAGES OF PROFICIENCY
1. Novice:
- Novices are beginners who have limited
experience and rely on rules and guidelines to
make decisions. They lack the practical
knowledge and expertise needed for complex
situations.
2. Advanced Beginner:
- At this stage, individuals gain some experience
and start to recognize recurring situations.
They can now begin to make some decisions
based on their previous experiences.
3. Competent:
- Competent practitioners have gained a good
amount of experience and are able to analyze
situations and make decisions more efficiently.
They have a deeper understanding of patient
care.
4. Proficient:
- Proficient nurses have developed a holistic
view of patient care and can see the big
picture. They can anticipate and interpret
complex situations and are more intuitive in
their decision-making.
5. Expert:
- Experts have extensive experience and can
make decisions quickly and effectively. They
have a deep understanding of patient care,
and their actions are often intuitive. They can
handle complex and unpredictable situations
with ease.
PURPOSE AND MAJOR CONCEPTS
 Benner’s model delineates the importance of
retaining and rewarding nurse clinicians for their
clinical expertise in practice settings because it
describes the evolution of “excellent caring
practices”.
 Benner notes that research demonstrates that
practice grows “through experiential learning and
through transmitting that learning in practical
settings” (Benner, 2001, p. vi)
 Expertise develops when the clinician tests and
refines propositions, hypotheses and principle-
based expectations in actual practice situations.
 The model seeks to describe clinical expertise
including six areas of practical knowledge- graded
qualitative distinctions; common meanings;
assumptions, expectations and sets; paradigm
cases and practical knowledge; maxims; and
unplanned practices.
CENTRAL CONCEPTS OF BENNER’S MODEL
 Competence
 Skill Acquisition
 Experience
 Clinical Knowledge
 Practical Knowledge
DOMAINS OF NURSING PRACTICE
 Helping role
 Teaching or coaching function
 Diagnostic client-monitoring function
 Effective management of rapidly changing
situations
 Administering and monitoring therapeutic
interventions and regimens
 Monitoring and ensuring quality of health care
practices
 Organizational and work role competencies
ANNE BOYKIN AND SAVINA SCHOENFER
- Theory of Nursing as Caring
ANNE BOYKIN
 Born in 1944
 Grew up in Wisconsin
 2nd eldest of 6 children
1966 – she began her career in nursing, graduating from
Alverno Collee in Milwaukee, Wisconsin
 Today, she enjoys the beauty of South Florida as
the dean and professor of the College of Nursing at
FAU
SAVINA SCHOENFER
 Born in 1940
 2nd child and oldest daughter in a family on 9
 Spent her formative years on the family cattle
ranch on Kansas
 Her initial nursing study was completed at Wichita
State University where she earned undergraduate
and graduate degrees in nursing, psychology, and
counselling
KEY ASPECTS OF THEIR COLLABORATIVE WORK
 • Caring as Central Major Concepts and Relationships; A shift to a More
• Ten Carative Factors Caring Paradigm
• Transpersonal Relationships
• Human Becoming and Possibilities The Nursing Paradigm: in the Mine of Katie Erikson
• Holistic Care  Person – the patient is a suffering human being or
THEORY OF NURSING AS CARING a human being who suffers and patiently endures
• places a strong emphasis on caring as the central  Environment
focus of nursing and has had a significant impact Caring Culture Concept
on the field of nursing practice and education. - characterizes the caring reality based on
• Like Jean Watson’s theory, this emphasizes the cultural elements
importance of the nurse-patient relationship and - transmission of value preferences (ethos)
the role of caring in promoting well-being and - preserving respect, dignity, and holiness of the
healing human being
KATIE ERIKKSON  Nursing
- THEORY OF CARATIVE CARING (1988) - Caritative Care ethics makes basic distinction
 1965 - PRESENT between caring and nursing ethics
 Finland-Swedish nurse - Caring Ethics the core of nursing ethics, deals
1965 – she attended nursing school to become a practicing with patient-nurse relationship
nurse - Nursing Ethics deals with ethical principles and
 Became a nursing instructor at Helsinki Swedish rules that guide nursing decisions
Medical Institute STRENGTHS AND WEAKNESSES OF ERIKSON’S THEORY
 Currently works as a professor of health sciences at STRENGTHS
Abo Akademi University in Vaasa, where she built a 1. Holism
master’s degree program leading to a doctoral 2. Acknowledges willingness of person caregiver or
degree in health sciences patient
 Also responsible for research and development of 3. Nurse willingness to act without prejudice
the Caring Sciences Department 4. Altruistic
THEORETICAL FOUNDATIONS WEAKNESSES
CARITAS 1. Abstract
- the motive that is the substance of care, 2. Spiritually based
expressed in ways of alleviating human 3. Lack of international use in nursing education
suffering and preserving health and life 4. Nurse willingness to self-sacrifice
- understanding of humans as soul & spirit,
residing in a body that is both holy and
spiritual
- caring identifies with suffering, sees dignity as
serving with love for the sake of others
- theory exploded further: Erikson, Peterson, &
Zetterlund’s, The suffering human being
CARATIVE CARE THEORY
 A model of nursing which distinguishes between
caring ethics, the practice; relationship between
the patient and the nurse, and nursing ethics
 Nursing ethics are the ethical principles that guide
a nurse’s decision-making abilities
 Caritative caring consists of love and charity, which
is also known as caritas, and respect and reverence
for human holiness and dignity.
 Suffering that occurs as a result of a lack of
caritative care is a violation of human dignity.
ASSUMPTIONS OF CARITATIVE CARE THEORY
1. The human being: Patient and Caregiver/Nurse
2. Suffering and Health
3. The Caritas Motive – The ethics of caring
4. Caring – Compassion, Invitation and commitment
to the relationship, Faith, Hope and Love
5. The caring communion