CHAPTER 2: NURSING

THEORETICAL WORKS
LEARNING OBJECTIVES

• 1. Identified Nursing Philosophies

• 2. Discussed the Nursing conceptual Model
• 3. Compare each nursing theories
• 
 Nursing Theorist Theory

Florence Nightingale Environment theory

Hildegard Peplau Interpersonal theory

Virginia Henderson Need Theory

Faye Abdella Twenty One Nursing Problems

 Nursing Theorist Theory

Ida Jean Orlando Nursing Process theory

Dorothy Johnson System model

Martha Rogers Unitary Human beings

Dorothea Orem Self-care theory

 Nursing Theorist Theory

Imogene King Goal Attainment theory

Betty Neuman System model

Sister Calista Roy Adaptation theory

Jean Watson Philosophy and Caring Model

 Nursing Theorist Theory

Madeleine Leininger Transcultural nursing

Patricia Benner From Novice to Expert

Lydia E. Hall The Core, Care and Cure

Margaret Newman Health As Expanding Consciousness

 Nursing Theorist Theory

Katharine Kolcaba Comfort Theory

Rosemarie Rizzo Parse Human Becoming Theory
Ernestine Wiedenbach The Helping Art of Clinical Nursing
Joyce Travelbee Human-To-Human Relationship
Model
 LESSON 1: NURSING PHILOSOPHIES:

1. Nightingale’s Environmental Theory

2. Watson’s Theory of Human Caring
3. Benner Benner’s Stages of Nursing Expertise
Nursing Philosophies
4. Erikson’s Caritative Caring Theory
THEORY OF FLORENCE NIGHTINGALE

• The goal of nursing is “to put the patient in the best

condition for nature to act upon him”. – Nightingale
 INTRODUCTION

• As the founder of modern nursing, Florence Nightingale’s Environment

Theory changed the face of nursing practice. She served as a nurse during
the Crimean War, at which time she observed a correlation between the
patients who died and their environmental conditions. As a result of her
observations, the Environment Theory of nursing was born. Nightingale
explained this theory in her book, Notes on Nursing: What it is, What it is
Not. The model of nursing that developed from Nightingale, who is
considered the first nursing theorist, contains elements that have not
changed since the establishment of the modern nursing profession. Though
this theory was pioneering at the time it was created, the principles it
applies are timeless.
Born - 12 May 1820
• Founder of modern nursing.
• The first nursing theorist.
• Also known as "The Lady with the Lamp"
• She explained her environmental theory in her
famous book Notes on Nursing:
• What it is, What it is not .
• She was the first to propose nursing required specific education
and training.
• Her contribution during Crimean war is well-known.
• She was a statistician, using bar and pie charts, highlighting key
points.
• International Nurses Day, May 12 is observed in respect to her
contribution to
• Nursing.
• Died - 13 August 1910
• Assumptions of Nightingale's Theory
• Natural laws
• Mankind can achieve perfection
• Nursing is a calling
• Nursing is an art and a science
• Nursing is achieved through environmental alteration
• Nursing requires a specific educational base
• Nursing is distinct and separate from medicine
Nightingale’s Canons: Major Concepts
1. Ventilation and warming
2. Light
3. Noise
4. Cleanliness of rooms and walls
5. Health of houses
6. Bed and bedding
7. Personal cleanliness
8. Variety
9. Chattering hopes and advices
10.Taking food. What food?
11.Petty management
12.Observation of the sick
1. Ventilation and Warming
•Nightingale believed that it was essential to “keep the breathes as pure as the external
air without chilling him.
•she believe that the person who repeatedly breath his/her own air would be sick or
remain sick.
•Nightingale also believed that “ noxious air” or “effluvia” or foul odors affect the client’s
health. This come from raw, sewage, ditches, excrement, bedpans, urinals and other
utensils used to discard excrement.
•She believed that the offensive source, not the smell must be removed. So she criticized “
fumigations”
•Nightingale also emphasized the importance of room temperature. The patient should
not be too warm or too cold.
2. Light
• Nightingale advocated that the sick needs both fresh and light- direct
sunlight was what clients wanted.
• She noted that light has” quite real and tangible effects upon the human
body”
• She noted that the sick rarely lie with their face toward the wall but are
much more likely to face the window , the source of the sun.
• In these modern times it is still noted that luck of environmental stimuli
like isolation rooms, NICU, ICU, etc. , can lead to confusion or “ intensive
care psychosis: related to the lack of the usual cycling of day and night.
3. Noise
• Nightingale believed that patients should never be waked
intentionally or accidentally during the first part of sleep.
• She averred that whispered or long conversations about patients are
thoughtless and cruel, especially when held so that the patient knows
( or assumes) the conversation is about him.
• In these modern times, noises that may irritate patients are jewelries
worn by nurses, keys that jingle, snapping of rubber gloves, the clank
of the stethoscope against metal bed rails, radios, TV’s, telephones
ringing, machines that beep or alarm, etc.
4. Cleanliness of rooms and walls
•Nightingale emphasized that “ the greater part of nursing consists
in preserving cleanliness.
•She urges the removal of dust with the used of damp clothe rather
than a feather duster. Floors should be easily cleaned rather than
being covered with dust trapping carpets. Furniture and walls
should be easily washed and not damaged by coming in contact
with moisture.
•In modern times, the concept that a clean room is a healthy room
continues to be relevant.
5. Health of houses
• Is closely related to the presence of pure air, pure water, efficient
drainage, cleanliness and light.
• According to nightingale, “ badly constructed houses do for the healthy
what badly constructed hospitals do for the sick. One stagnant air is
stagnant, sickness is certain to follow”( Nightingale , 1859, p.15)
• She also noted that the cleanliness outside the house affected the inside.
• Nightingale’s advocacy is still applicable in these modern times,
because families can be still affected by toxic wastes, contaminated
water and polluted air.
6. Bed and bedding
•Nightingale postulated that an adult exhales about three pints of moisture
through the lungs and skin in a 24 hour period. This organic matter, she
said, enters the sheets and stays there unless the bedding is changed and
aired frequently.
•She believed that the bed should be placed in the lightest part of the room
and placed so the patient could see out of the window.
•She reminded the caregiver never to lean against, sit upon, or
unnecessarily shake the bed of a patient.
•Even in the modern times, it remains important for the nurse to keep
bedding clean, neat, and dry and to position the patient for maximum
comfort.
7. Personal cleanliness
• Nightingale viewed the function of the skin as
important.
• She believed that unwashed skin poisoned the patient
and noted that bathing and drying the skin provided
great relief to the patient.
8. Variety
•Nightingale stressed that variety in the environment was a critical
aspect affecting the patient’s recovery.
•She believed in the need for changes in color and form, including
bringing the patient brightly colored flowers or plants.
•She also advocated rotating 10 to 12 paintings and engravings
each day, week, or month to provide variety for the patient.
•She agreed that the mind greatly affects the body.
•She also advocated reading, needlework, writing and cleaning
activities to relieve the sick of boredom.
9. Chattering hopes and advices
• Nightingale perceived that to cheer the sick by making light of
their illness and its danger is not helpful.
• She considered it stressful for a patient to hear opinions after only
brief observations had been made. False hope was depressing to
patients, she felt, and caused them to worry and become fatigued.
• Nightingale encouraged the nurse to heed what is being said by
visitors, believing that sick person should hear good news that
would assist them in becoming healthier.
10.Nutrition and Taking food. What food?
• Nightingale addressed the importance of variety in the food served to
patient.
• She has proven that the attention given to the patient affected how the
patient ate.
• She has observed that individuals desire different foods at different times
of the day and that frequent small servings maybe more beneficial to the
patient has a large breakfast or dinner.
• She urged that no business be done with patient while they are eating
because this was distraction. She also urged that the right food be brought
at the right time and “ be taken away, eaten or eaten, at the right time.”
11. Petty management
• Nightingale discussed “ petty management’ or ways to assure
that “what you do when you are there, shall be done when
you are not there”
• She believed that the house and the hospital needed to be
well-managed- that is organized, clean, and appropriate
supplies.
12. Observation of the sick
• According to Nightingale “ at most important practical lesson that can be
given to nurses is to teach them
• what to observe
• how to observe
• what symptoms indicate improvement
• what is the reverse
• which are of importance
• which are one
• which are evidence of neglect----and what kind of neglect”( Nightingale, 1859,
p.59)
Nursing Paradigms
•Nightingale's documents contain her philosophical
assumptions and beliefs regarding all elements found
in the metaparadigm of nursing. These can be
formed into a conceptual model that has great utility
in the practice setting and offers a framework for
research conceptualization. (Selanders LC, 2010)
Nursing
• Nursing the best possible condition for nature to act.
is different from medicine and the goal of nursing is to
place the patient in the best possible condition in order
for nature to act.
• Nursing is the "activities that promote health (as
outlined in canons) which occur in any caregiving
situation. They can be done by anyone."
Person
• People are multidimensional, composed of biological,
psychological, social and spiritual components.
Health
• Health is “not only to be well, but to be able to use well
every power we have”.
• Disease is considered as disease or the absence of
comfort.
Environment
• "Poor or difficult environments led to poor health
and disease".
• "Environment could be altered to improve conditions
so that the natural laws would allow healing to
occur."
 NIGHTINGALE'S THEORY AND NURSING PRACTICE
 
Application of Nightingale's theory in practice:
• "Patients are to be put in the best condition for nature to
act on them, it is the responsibility of nurses to reduce
noise, to relieve patients’ anxieties, and to help them
sleep."
• As per most of the nursing theories, environmental
adaptation remains the basis of holistic nursing care.
Criticisms
• She emphasized subservience to doctors.
• She focused more on physical factors than on
psychological needs of patient.
Applications of Nightingale's Theory
• Nightingale theory and intentional comfort touch in
management of tinea pedis in vulnerable populations.
• Incorporating Florence Nightingale's theory of nursing into
teaching a group of preadolescent children about negative peer
pressure.
Conclusion
• Florence Nightingale provided a professional model for nursing
organization.
• She was the first to use a theoretical foundation to nursing.
• Her thoughts have influenced nursing significantly.
• According to Nightingale, nursing is separate from medicine. The goal of
nursing is to put the patient in the best possible condition in order for
nature to act. Nursing is “the activities that promote health which occur
in any caregiving situation.” Health is “not only to be well, but to be able
to use well every power we have.” Nightingale’s theory addresses disease
on a literal level, explaining it as the absence of comfort.
• The environment paradigm in Nightingale’s model is
understandably the most important aspect. Her observations taught
her that unsanitary environments contribute greatly to ill health,
and that the environment can be altered in order to improve
conditions for a patient and allow healing to occur.
• Nightingale’s Modern Nursing Theory also impacted nursing
education. She was the first to suggest that nurses be specifically
educated and trained for their positions in healthcare. This allowed
there to be standards of care in the field of nursing, which helped
improve overall care of patients.
 NIGHTINGALE AND THE NURSING
PROCESS
Assessment
•Nightingale recommended two essential behaviors by the nurse in the area of assessment.
1. Ask the client what is needed or wanted.
Examples:
a. If the patient is in pain, ask where the pain is located.
b. If the patient is not eating, ask when he or she would like to eat and what food is
desired.
•She recommended asking precise questions. She warned against asking leading questions.
Correct: “ How many hours of sleep did you have? At what hours of the night?
Wrong: ‘Did you have a good night sleep?
2. Observation. She used precise and specific observations
concerning all aspects of the client’s physical health environment.
• Examples:
a. How do light, noise, smells, and bedding affect the client?
b. How much food and drink had the client ingested at every
meal or snack?
Nursing Diagnoses
• Nightingale believed data should be used as the basis for
forming any conclusion. The nursing diagnosis is the client’s
response the environment and not the environmental
problem. It reflects the importance of the environment to
health and well-being of the client.
• Outcomes and Planning
• Identifying the nursing actions needed to keep the clients
comfortable, dry, and in the best state for nature to act on.
• Planning is focused on modifying the environment to enhance
the client’s ability to respond to the disease process.
• The desired outcomes are derived from the environmental
model---- for example, being comfortable, clean, dry, in the
best state for nature to work on.
• Implementation
• Takes place in the environment that affects the client
and involves taking action to modify that environment.
• All factors of the environment should be considered,
including noise, air. Odors, bedding, cleanliness, light---
• All the factors that place clients in the best position for
nature to work upon them.
• Evaluation
• Is based on the effect of the changes in environment on
the client’s ability to regain his/her health at the least
expense of energy.
• Observation is the primary method of data collection
used to evaluate the client’s response to the
intervention.
 CRITICAL THINKING WITH NIGHTINGALE’S THEORY

Nightingale’s 13 Canons Nursing Process and Thought

( Nightingale, 1969, Selanders 1998)  

  Assess the client’s body temperature, room

Ventilation and Warmth temperature, and room for fresh air ( or adequate
  ventilation) and foul odors. Develop a plan to keep the
room airy and free of odor while maintaining the
client’s body temperature.

Light Assess the room for adequate light. Sunlight works

best. Develop and implement adequate light in the
client’s room without placing the client in the direct
light.
Cleanliness of rooms and walls
Health of houses
Assess the room for dampness, darkness,
and dust or mildew. Keep the room free
from dust, dirt, mildew and dampness.
Assess the surrounding environment for
pure air, pure water, drainage, cleanliness,
and light Examples include removing
garbage or garments from the area,
removing any standing water( or ensuring
that water drains away from the area), and
ensuring that air and water are clean and
free from odor and that there is plenty of
light.
Noise Assess the noise level in the client’s room and
surrounding area. Attempt to keep noise level
to a minimum, and refrain from whispering
outside the door.

Bed and bedding Assess the bed and bedding for dampness,
wrinkles, and soiling, and check the bed for
height. Keep the bed dry, wrinkle-free, and at
the lowest height to ensure the client’s
comfort.
Personal cleanliness Attempt to keep the client dry and clean at
all times. Frequent assessment of the client’s
skin is needed to maintain adequate skin
moisture.
   
  Attempt to stimulate variety in the room and
  with the client. This is accomplished with
Variety cards, flowers, pictures, books, or puzzles.
Encourage friends and relatives to engage the
client in some sort of stimulating
conversation.
Chattering hopes and advices Avoid talking without reason or giving
advice that is without fact. Continue to talk
to the client as a person, and continue to
stimulate the client’s mind. Avoid personal
talk.

Nutrition and Taking food Assess the diet of the client. Take note of the
amount of food and drink ingested by the
client at very meal or snack.
What food Continue with the assessment of the diet to
include type of food and drink the client likes
or dislikes. Attempt to ensure that the client
always has some food or drink available that
he or she enjoys.

Petty management Petty management ensures continuity of care.

Documentation of the plan of care and all
evaluation will ensure others give the same
care to the client in your absence.
Observation of the sick Observe everything about your
client. Record all observations.
Observations should be factual
and not merely opinions.
Continue to observe the client’s
surrounding environment, and
make relations in the plan of care
when needed.
Client and Environment in Balance
 APPLICATION OF FLORENCE NIGHTINGALE’S
ENVIRONMENTAL PHILOSOPHY
• Case History of Angel Gonzaga
Miss Angel Gonzaga is a 25 year old female who had been admitted to the
medical unit with the chief complaint of frequent, watery stools since last
night. This is accompanied by abdominal cramps, nausea and vomiting.
Her vital signs are as follows: Temperature- 38.6 C, Pulse- 98bpm,
Respiration- 23 bpm, BP- 100/70 mm Hg. She complains of weakness, thirst
and dryness of mouth. Her skin is warm, flushed, and dry. Her urine is
dark yellow in color.
• Miss Gonzaga claims, she had eaten oysters for dinner. She
lives in a crowded community close to a landfill and shares
toilet with 4 other families. Their source of drinking water is
from pump well in the community. She does not practice good
hand washing after using the toilet. Stool examination revealed
salmonellosis.
• Miss Gonzaga is extremely tearful. She expresses great
concern over her health and expenses for hospitalization.
 NURSING CARE OF MISS ANGEL GONZAGA
WITH NIGHTINGALE’S THEORY

• In Nightingale’s environmental theory, Miss Gonzaga is the

Person seeking care. She needs nature’s reparative process.
• The nursing process and Nightingale’s theory can be used
together to provide care for Miss Gonzaga. This care involves “
nursing the sick”, review of the environment and the client’s
lifestyle.
 A. NURSING THE SICK
• Assessment
Assess the client for the following problems:
1. Fluids and electrolyte losses related to frequent, watery stools, nausea
and vomiting as manifested by changes in the VS; weakness, dryness of
mouth; warm, flushed, dry skin; dark colored urine.
2. Pain related to abdominal cramps.
3. Inadequate fluid intake related to nausea and vomiting.
4. Fever ( T- 38.6 C) related to infection( Salmonellosis) and dehydration.
 PLAN
1. Fluid and electrolyte losses.

• Provide fluid and electrolyte replacement.

• Administer medications to relieve frequent, watery stools and nausea and
vomiting as prescribed.
• Provide good oral care for dryness of mouth.
• Promote rest to relieve weakness.
• Monitor intake and output. To assess fluid balance status.
• Provide good perianal care.
2. Pain related to abdominal cramps.
• Provide low fiber diet. To reduce peristalsis
• Promote rest. To reduce peristalsis and promote comfort
• Avoid gas- forming foods. Flatulence worseness abdominal
pain.
• Administer anti cholinergic as prescribed. To relieve
abdominal cramps.
3. Inadequate food intake related to nausea and vomiting.

• Provide small, frequent feedings. This is better tolerated by

patients with nausea.
• Provide ice chips to relieve nausea.
• Administer anti emetic as prescribed. To relieved nausea and
vomiting.
4. Fever related to infection and dehydration.
• Provide adequate room ventilation.
• Keep the room airy and free of odor. To promote rest.
• Increase fluid intake. To reduce fever, relieve dehydration, and promote excretion of
microorganism.
• Administer antibiotic and antipyretic as prescribed.
• Render tepid sponge bath. To reduced fever by evaporation and conduction.
• Keep the skin clean and dry. To promote comfort.
• Change gowns and bedding as needed to prevent dampness from perspirations.
• Observation of the sick. Observe everything about the client. Record all observations
which are factual and not merely opinions.
 B. PHYSICAL ENVIRONMENT

• Home, community/ neighborhood and workplace Assessment

1. Pure water. Assess for adequate working water system and
storage that is free from contamination.
2. Cleanliness. Assess for sanitation conditions of food sources and
preparation and hygienic practices.
3. Assess for the means to maintain sanitation conditions of the
toilets. To keep Food and water supply free from contamination.
 HOME, COMMUNITY/ NEIGHBORHOOD AND
WORK PLACE PLAN
1. Water
• Have water checked for contamination in coordination with local
Department of Health Personnel.
• Educate the client on water purification and storage methods.
• Keep garbage and other, refuse away from water supply or any parts
of the water system.
2. Cleanliness
• Educate the client on proper food handling; the importance
of hand washing especially when preparing foods and before
and after using the toilet; proper waste disposal and personal
cleanliness.
 HOME AND WORKPLACE ASSESSMENT
1. Light. Assess for adequate windows and working light sources.
2. Pure Air. Assess for ventilation, offensive odors, (e.g. odor of garbage in
the
landfill).
3. Water. Assess for working system that is free from contamination.
4. Drainage. Assess the area for drainage of water from washing dishes
and laundry ; drainage of rain water away from the home.
 5. Cleanliness. Assess the home and workplace for means to keep the areas
clean, and freedom from excessive dust, molds, mildew, pet droppings ( from
cats and
dogs), offensive odors, “ dust catcher” things ( files of papers, unused jars,
plastic container, unused old clothes, etc.)
6. Bed and bedding. Assess the bed for space and comfort. Assess the bedding for
Cleanliness and availability of areas for laundry and drying of bedding( for
home
Environment only).
7. Noise. Assess the area for loud, offensive and unnecessary noise.
 PSYCHOLOGICAL ENVIRONMENT
• Assessment and Plan
Miss Angel Gonzaga has several psychological concerns. She is worried over her
absence from her job, her health, and expenses for hospitalization.
1. Variety. Assess the client’s activities before illness. Attempt to stimulate variety in
the Room and with the client during her hospital stay- with cards, flowers, magazines,
books Music. Encourage visits of relatives and friends.
2. Chattering hopes and advices. Refrain from giving the patient your opinion. Provide
factual information about health. Allow her to verbalize her fears, feelings and
concerns.
 SUMMARY:
• Nightingale’s Theory in Nursing is timeless. Her writings are as
meaningful today as they were in the nineteenth century. Her
13 canons ( see Critical Thinking with Nightingale’s Theory)
may differ in the specifics of application today, but the
underlying principles provided by Nightingale remain sound
and relevant.
• Nightingale’s theory applies in all situations that nursing care is
provided.
JEAN WATSON'S PHILOSOPHY OF NURSING
THEORY OF TRANSPERSONAL CARING
 INTRODUCTION:

• Theorist - Jean Watson was born in West Virginia, US

• Educated: BSN, University of Colorado, 1964, MS, University
of Colorado, 1966, PhD, University of Colorado, 1973
• Distinguished Professor of Nursing and Chair in Caring
Science at the University of Colorado Health Sciences Center.
Fellow of the American Academy of Nursing.
• Dean of Nursing at the University Health Sciences Center and
President of the National League for Nursing
• Undergraduate and graduate degrees in nursing and psychiatric-
mental health nursing and PhD in educational psychology and
counseling.
• Six (6) Honorary Doctoral Degrees.
• Research has been in the area of human caring and loss.
In 1988, her theory was published in “nursing: human science and
human care”.
 THE SEVEN ASSUMPTIONS
1. Caring can be effectively demonstrated and practiced only interpersonally.
2.Caring consists of carative factors that result in the satisfaction of certain human needs.
3. Effective caring promotes health and individual or family growth.
4. Caring responses accept person not only as he or she is now but as what he or she
may become.
5. A caring environment is one that offers the development of potential while allowing
the person to choose the best action for himself or herself at a given point in time.
6. Caring is more “ healthogenic” than is curing.
7. A science of caring is complementary to the science of
curing.
• The practice of caring is central to nursing.
• The ten primary carative factors
• The formation of a humanistic- altruistic system of values.
• The installation of faith-hope.
• The cultivation of sensitivity to one’s self and to others.
• The development of a helping-trust relationship
• The promotion and acceptance of the expression of positive and negative
feelings.
• The systematic use of the scientific problem-solving method for decision
making.
• The promotion of interpersonal teaching-learning.
• The provision for a supportive, protective and /or corrective mental,
physical, socio-cultural and spiritual environment.
• Assistance with the gratification of human needs.
• The allowance for existential-phenomenological forces.
• The first three carative factors form the “philosophical foundation” for
the science of caring. The remaining seven carative factors spring from
the foundation laid by these first three.
1. The formation of a humanistic- altruistic system of values Begins
developmentally at an early age with values shared with the parents.
Mediated through ones own life experiences, the learning one gains and
exposure to the humanities. Is perceived as necessary to the nurse’s own
maturation which then promotes altruistic behavior towards others.
2. Faith-hope
• Is essential to both the carative and the curative processes.
When modern science has nothing further to offer the person,
the nurse can continue to use faith-hope to provide a sense of
well-being through beliefs which are meaningful to the
individual.
3. Cultivation of sensitivity to one’s self and to others
• Explores the need of the nurse to begin to feel an emotion as it presents
itself.
• Development of one’s own feeling is needed to interact genuinely and
sensitively with others.
• Striving to become sensitive, makes the nurse more authentic, which
encourages self-growth and self-actualization, in both the nurse and
those with whom the nurse interacts.
• The nurses promote health and higher level functioning only when they
form person to person relationship.
4. Establishing a helping-trust relationship
• Strongest tool is the mode of communication, which establishes
rapport and caring.
• Characteristics needed to in the helping-trust relationship are:
Congruence
Empathy
Warmth
• Communication includes verbal, nonverbal and listening in a
manner which connotes empathetic understanding.
5. The expression of feelings, both positive and negative
• “Feelings alter thoughts and behavior, and they need to
be considered and allowed for in a caring relationship”.
• Awareness of the feelings helps to understand the
behavior it engenders.
6. The systematic use of the scientific problem-solving
method for decision making
• The scientific problem- solving method is the only
method that allows for control and prediction, and that
permits self-correction.
• The science of caring should not be always neutral and
objective.
7. Promotion of interpersonal teaching-learning
• The caring nurse must focus on the learning process as
much as the teaching process.
• Understanding the person’s perception of the situation
assist the nurse to prepare a cognitive plan.
8. Provision for a supportive, protective and /or corrective
mental, physical, socio-cultural and spiritual environment
• Watson divides these into external and internal variables,
which the nurse manipulates in order to provide support and
protection for the person’s mental and physical well-being.
• The external and internal environments are interdependent.
• Nurse must provide comfort, privacy and safety as a part of
this carative factor.
9. Assistance with the gratification of human needs
• It is based on a hierarchy of need similar to that of the Maslow’s.
• Each need is equally important for quality nursing care and the
promotion of optimal health.
 All the needs deserve to be attended to and valued.
Watson’s ordering of needs
Lower order needs (biophysical needs)
The need for food and fluid
The need for elimination
The need for ventilation
Lower order needs (psychophysical needs)
The need for activity-inactivity
The need for sexuality
Higher order needs (psychosocial needs)
The need for achievement
The need for affiliation
Higher order need (intrapersonal-interpersonal need)
The need for self-actualization
10. Allowance for existential-phenomenological forces
• Phenomenology is a way of understanding people from the way things
appear to them, from their frame of reference.
• Existential psychology is the study of human existence using
phenomenological analysis.
• This factor helps the nurse to reconcile and mediate the incongruity of
viewing the person holistically while at the same time attending to the
hierarchical ordering of needs.
• Thus the nurse assists the person to find the strength or courage to
confront life or death.
 WATSON’S THEORY AND THE FOUR MAJOR
CONCEPTS

1. Human being
• Human being refers to “….. a valued person in and of him or
herself to be cared for, respected, nurtured, understood and
assisted; in general a philosophical view of a person as a fully
functional integrated self. He, human is viewed as greater than
and different from, the sum of his or her parts”.
2. Health
• Watson adds the following three elements to WHO definition
of health:
• A high level of overall physical, mental and social functioning
• A general adaptive-maintenance level of daily functioning
• The absence of illness (or the presence of efforts that leads its
absence)
3. Environment/society
• According to Watson, caring (and nursing) has existed in every
society.
• A caring attitude is not transmitted from generation to
generation.
• It is transmitted by the culture of the profession as a unique
way of coping with its environment.
4. Nursing
• “Nursing is concerned with promoting health, preventing illness,
caring for the sick and restoring health”.
• It focuses on health promotion and treatment of disease. She
believes that holistic health care is central to the practice of caring
in nursing.
• She defines nursing as…..“a human science of persons and human
health-illness experiences that are mediated by professional,
personal, scientific, esthetic and ethical human transactions”.
 WATSON’S THEORY AND NURSING
PROCESS
Nursing process contains the same steps as the scientific research process. They
both try to solve a problem. Both provide a framework for decision making.
1. Assessment
• Involves observation, identification and review of the problem; use of
applicable knowledge in literature.
• Also includes conceptual knowledge for the formulation and conceptualization
of framework.
• Includes the formulation of hypothesis; defining variables that will be
examined in solving the problem.
2. Plan
• It helps to determine how variables would be examined or
measured; includes a conceptual approach or design for
problem solving. It determines what data would be collected
and how on whom.
3. Intervention
• It is the direct action and implementation of the plan.
• It includes the collection of the data.
4. Evaluation
• Analysis of the data as well as the examination of the
effects of interventions based on the data.
• Includes the interpretation of the results, the degree to
which positive outcome has occurred and whether the
result can be generalized.
•It may also generate additional hypothesis or may even lead to the
generation of a nursing theory.
Watson’s theory and the characteristic of a theory
Logical in nature
Relatively simple
Generelizable
•Based on phenomenological studies that generally ask questions rather than
state hypotheses.
•Can be used to guide and improve practice.
•Supported by the theoretical work of numerous humanists, philosophers,
• developmentalists and psychologists.
 STRENGTHS
• This theory places client in the context of the family, the community
and the culture.
• It places the client as the focus of practice rather than the
technology.
• Limitations
• Biophysical needs of the individual are given less important.
• The ten caratiive factors primarily delineate the psychosocial needs
of the person.
• Needs further research to apply in practice.
• Research related to Watson’s theory
• The effectiveness of Watson's Caring Model on the quality of life
and blood pressure of patients with hypertension. J Adv Nurs.
2003 Jan;41(2):130-9.
Ex. This study demonstrated a relationship between care
given according to Watson's Caring model and increased
quality of life of the patients with hypertension. Further,
in those patients for whom the caring model was
practiced, there was a relationship between the Caring
model and a decrease in patient's blood pressure. The
Watson Caring Model is recommended as a guide to
nursing patients with hypertension, as one means of
decreasing blood pressure and increase in quality of life.
 CONCLUSION
• Watson provides many useful concepts for the practice of
nursing.
• She ties together many theories commonly used in nursing
education.
• The detailed descriptions of the carative factors can give
guidance to those who wish to employ them in practice or
research.