NURSING

PHILOSOPHIES
Florence Nightingale
Florence and the Patient
Nightingale believed that caring for
the sick was a component of
Christianity
Cures were not limited to medical
acts but also acts of God
Patient’s needs should be prioritized
according to Maslow’s Hierarchy
 Florence and the
Patient
Health Promotion occurred through providing a
sanitary environment, adequate nutrition,
patient comfort, and conservation of the
patient’s energy

Considered a client to have the capability to be

healthy, however, he/she did not have the
power to control their unsanitary environment
or poor access to essential nutrients
Florence’s Theory and Health
Although Florence Nightingale was bedridden, she continued
to campaign to improve the heath standards, publishing 200
books, reports and pamphlets.

She believed that infection arose spontaneously in dirty and

poorly ventilated places
Her belief led to improvements in hygiene and healthier living
and working environments
Florence Nightingale’s vision of health care included
professional nursing for the sick and the poor
Florence’s Theory and
Health
One of the first people to examine data on
occupational health and safety

Systemic approach to health care with a

major role for prevention, clean air, clean
water, decent housing and good infant
care
Promoted uniform hospital statistics so that
results could be compared by country,
institution and type of treatment
 Florence and the
Environment

Mother’s responsibility to teach her children

cleanliness in mind, body, and spirit
This included waste management and
tidiness in and around the home

Bad smells were to be considered a sign of

danger
 Florence and the
Environment

In order for healing to occur, all

environmental and sanitary
conditions must improve

Ventilation/ Clean Air and light were

considered key factors in hygiene
Florence and Nursing
Florence Nightingale is the reason why nursing is considered a profession today and recognized that educated nurses would be viewed by the public as
professional.

First nursing school at St. Thomas Hospital in London

She believed that God called her to be a nurse and that He had natural laws that were to be followed
Florence and Nursing
According to Nightingale, the aim of nursing
education was to train women to become nurses
in order to serve society for the alleviation of the
suffering of the sick, for the amendment of the
living conditions of the poor, and for the
improvement of the health of the population
(Nightingale 1859).
The Effect on
Nursing Practice
Stressed the importance of hygiene and believed
that it aided in the prevention of disease
spreading
Focused on a holistic caring perspective
Aseptic practices
Nursing is a continuous learning process because
new and better practices are always being
developed
What it is, or what
it should be?
Maintaining a clean environment within the
healthcare setting is essential to prevent
nosocomial infections:
✔ Gloves and other PPE
✔ bed linens
✔ Handwashing
✔ Keeping a clear path for fire safety
What it is, or what it should be?
However, not everyone always follows the
rules:
Carts, etc. obstructing the hallways
Not everyone wears gloves when they are
supposed to
Handwashing
Florence Nightingale’s Theory is one that
every nurse should strive to achieve by
maintaining a healthy environments not
only for their patients, but also for
themselves.
JEAN WATSON
 JEAN WATSON
✢ “Theory of Transpersonal
Nursing/

Philosophy and Science of Human

Caring”
Jean Watson: “Theory of Transpersonal Nursing”

The Major elements of her theory are:

A. Carative factors
B. Transpersonal caring relationship
C. The caring occasion/ caring moment
Jean Watson:
“Theory of Transpersonal Nursing”

✢ Carative
○ means caring with love
○ “caritas”- to cherish,
appreciate, and give special
attention
Jean Watson:
“Theory of Transpersonal Nursing”
✢ Watson views the “Carative factors” as guide for the
core of nursing.
✢ Caring is central to nursing.
✢ Caring is more “healthogenic” than is curing.
✢ Effective caring promotes health and individual or
family growth.
 1. Humanistic-altruistic system of values.
2. The instillation of faith-hope
10 carative 3. The cultivation of sensitivity to one’s self and to
others.
factors 4. Developing helping-trust relationship, caring
relationship
5. Expressing positive and negative feelings and
emotions
 6. The systematic use of the scientific problem-solving
10 method for decision making.
7. Promotion of interpersonal teaching-learning
carative 8. Provision of a supportive, protective and/or
corrective mental, physical, socio-cultural and
factors spiritual environment.
9. Assistance with gratification of human needs.
10. Allowance for existential-phenomenological forces.
Transpersonal
caring relationship
“transpersonal”- means to go beyond one’s own ego
and the here and now, as it allows one to reach
deeper spiritual connections in promoting the
patient’s comfort and healing.
Transpersonal
caring relationship
✢ Goal- correspond to protecting,
enhancing and preserving the
person’s dignity, humanity, wholeness,
and inner harmony.
Caring occasion/
caring moment

✢ Nurse + another person= human caring

✢ It becomes “transpersonal” when “it allows for the
presence of the spirit of both- then the event of the
moment expands the limits of openness and has the
ability to expand human capabilities” (Watson, 1999)
Watson’s theory & the
nursing process
 A.Personhood(human being)
Concepts: ❖ Viewed holistically wherein the body,
mind and soul are interrelated; each
part a reflection of the whole, yet
the whole is greater than and
different from the sum of parts.
(Watson, 1979,1989)
Concepts:
A.Personhood(human being)
❖ Human being- valued person
❖ The soul fully participates in
healing.
 B. Healing space & environment
Concepts: ❖ The nurses’ role…
❖ 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.
Concepts:
B. Healing space & Environment
❖ The nurse becomes the
environment in which “sacred
space” is created
Concepts: C. Health, Illness & Disease

❖ Illness- subjective turmoil or

disharmony within a person’s inner self
or soul at some level of disharmony
within spheres of mind, body & soul.
Concepts: C. Health, Illness & Disease

❖ Disease- associated with

disharmony between the person
and the environment or nature
Concepts:
C. Health, Illness & Disease

❖ Within the transpersonal caring

relationship and the caring moment,
there is healing potential.
“THE FACT REMAINS THAT WE HOLD
ANOTHER’S LIFE IN OUR HANDS.”
(Watson, 2005)
PATRICIA BENNER
Novice-Expert
Model
Patricia Benner, RN,
PhD, FAAN, FRCN
Benner : As Author
Dr. Benner is the author of books including:
1.From Novice to Expert
2.The Primacy of Caring
3.Interpretive Phenomenology: Embodiment,
Caring and Ethics in Health and Illness
4. The Crisis of Care Practice: Caring,

5.Expertise inNursing Clinical Judgment, and Ethics

6. Caregiving

7. Clinical Wisdom and

Interventions in Critical Care: A Thinking-
 Is an internationally noted researcher and lecturer
on health, stress and coping, skill acquisition and
ethics.

 Recently elected an honorary fellow of the Royal

College of Nursing.

 Staff nurse in the areas of medical-surgical,

emergency room, coronary care, intensive care
units and home care.

 Currently, her research includes the study of

nursing practice in intensive care units and
nursing ethics.
An Influential Nurse in the Development of
the Profession of Nursing

Patricia Benner’s research

and
theory provides
with what
work the wenursing
now know
professionas the known as
also
model, Novice
of Stages of
Benner’sto
Competence.
Clinical Expert
Benner’s work as applied to
the profession isi
nursing
adapted from the
Dreyfus Model of
Skill Acquisition.
Skill Acquisition

“The utility of the concept of skill

acquisition lies in helping the
teacher understand how to assist
the learner in advancing to the
next level” (McClure, 2005)
The Dreyfus Model
of Skill
Acquisition
 Dr. Benner categorized nursing into 5 levels
of capabilities: novice, advanced beginner,
competent, proficient, and expert.
 She believed experience in the clinical setting
is key to nursing because it allows a nurse to
continuously expand their knowledge base
and to provide holistic, competent care to the
patient.
 Her research was aimed at discovering if
there were distinguishable, characteristic
differences in the novice’s and expert’s
descriptions of the same clinical incident.
 Novice
 The person has no background
experience of the situation in which
he or she is involved.
 There is difficulty discerning between
relevant and irrelevant aspects of the
situation.
 to profession
Beginner
area of or nurse
changing
practice (Frisch,
2009)

Generally this level applies to nursing
students.
 Novice

These inexperienced nurses function at

levelthe of instruction from nursing
school.
They are unable to make the leap from the classroom
lecture to individual patients. Often, they apply
rules learned in nursing school to all patients
and are unable to discern individual patient
needs. These nurses are usually new
graduates, or those nurses who return to the
workplace after a long absence and are re-
educated in refresher programs.
Advanced
Beginner
The advance beginner stage in the Dreyfus model develops who
the person can

demonstrate marginally acceptable

performance having coped with enough real
situations to note, or to have pointed out by
mentor, the recurring meaningful components
of the situation.
 Nurses functioning at this level are guided by
rules and oriented by task completion.
 Still requires mentor or experienced nurse to
assist with defining situations, to set priorities,
and to integrate practical knowledge (English,
1993)
 Competent
 After two to three years in the same area of nursing
the nurse moves into the Competent Stage of skill
acquisition.
 The competent stage is the most pivotal in clinical
learning because the learner must begin to
recognize patterns and determine which elements of
the situation warrant attention and which can be
ignored.
 The competent nurse devises
new rules and reasoning
procedures for a plan while
applying learned rules for action
on the basis of the relevant facts
of that situation.
 Proficient
 After three to five years in the same area of nursing the nurse moves into the
Proficient Stage
“The nurse possesses a deep understanding of situations as they occur, less
conscious planning is necessary, critical thinking and decision-making skills have
developed” (Frisch, 2009)

 The performer perceives the information as a

whole (total picture) rather than in terms of aspects and
performance.

 Proficient level is a qualitative leap beyond the competent.

 Nurses at this level demonstrate a new ability to see changing relevance in a

situation including the recognition and
the implementation of
skilled responses to the situation as is it
evolves.
 Expert
 This stage occurs after five years or greater in the same area of
nursing (experienced nurses changing areas of nursing practice may
progress more quickly through the five stages)
 The expert performer no longer relies on an analytic principle (rule,
guideline, maxim) to connect her or his understanding of the situation to
an appropriate action.
 The expert nurse, with an enormous
background of experience, now has an intuitive
grasp of each situation and
zeroes in on the accurate region of the problem
without wasteful consideration
of a large range of unfruitful, alternative
diagnoses and solutions.
 The expert operates from a deep understanding of the
total situation.
Benner’s Original Research
Goal:
–
Compare Novice & Expert Nurse’s descriptions and
responses to the same clinical situations
Participants:
– 21 nurse preceptors & 21 new graduate nurses
– 51 experienced nurses
– 11 newly graduated nurses
– 5 senior nursing students
Collection of Research:
– Interviews with narrative accounts of situations
– Observation of behaviors in clinical settings (Benner,
1984)
 Nursing Education
Incorporates Benner’ s
Theory
Goal:
Identify if simulating unstable patient scenarios by
–
providing interactive teaching will transition nursing
students to higher levels of expertise

Participants:
– 190 Adult Health Nursing Students
Collection of Research:
– Observation of students in simulated patient rooms with
manikins providing clues to clinical scenarios
Conclusion:
– Development of nursing competency requires practice
and clinical simulation provides a safe, structured
learning experience (Larew, Lessans, Spunt, Foster, and
Covington, 2006)
Nursing Application
of Benner’ s
Theory
Nursing applies Benner’s Theory through:
• Nursing school curriculum
• Building clinical ladders for nurses (Frisch, 2009)
• Developing mentorship programs
– Preceptors for student nurses
– Mentors for newly graduated nurses (Dracup
and Bryan- Brown, 2004)
•Development of the Clinical Simulation
Protocol (Larew et al., 2006)
Four Domains of
Nursing Paradigm

1. Client/Person
2. Health
3. Environment/Situation
4. Nursing
 Client/
Person
“The person is a self-
interpreting being, that is
the person does not come
into
the world predefined
but gets defined in the
course of living a
life.”
 Health

Dr. Benner focuses on the lived experience
of being healthy and being ill.

Health is defined as what can be assessed,
whereas well being is the
human experience of
health or wholeness.

Well being and being ill are
understood as distinct ways
of being in the world.
Environment/Situation
 Benner uses situation rather than environment
because situation conveys a social environment
with social definition .

 “To be situated implies that

one has a past, present, and
future and that all of these
aspects… influence the
current situation.”
- Dr. Benner
 Nursing
 Nursing is described as a
caring relationship, an
“enabling condition of connection
and concern.”
-Dr. Benner
 “Caring is primary because caring sets up the
possibility of giving and receiving help.”
 Nursing is viewed as a caring practice whose
science is guided by the moral art and ethics of
care and responsibility.
 Dr. Benner understands that nursing practice as the
care and study of the lived experience
of health, illness, and disease
and the relationships among the
KATIE
ERIKSSON
 KATIE ERIKSSON

“Caritative caring means that we take “caritas” into use

when caring for the human being in health and suffering…
Caritative caring is a manifestation of the love that “just
exist”… Caring communion, true caring, occurs when the
one caring in a spirit of caritas alleviates the suffering of
the patient.”
- Born in Nov. 18, 1943 in Jakobstad, Finland

- A graduate in Helsinki Swedish School of Nursing in 1965

- Established Department of Caring Science Abo Akademi

University in 1987 which developed the MA in health and the
caring science didactic education program.
- In 1987, eriksson with hers staff and researchers,
has further developed the Caritative Theory of
Caring and Caring Science as an academic
discipline.

- Presented her theory at the 14th IAHC conference

in Melbourne, Australia in 1992. and became
clearer in 1997.

- In 2003, she was honored nationally as a Knight,

First Class, of the White Rose in Finland.
 MAJOR CONCEPTS AND DEFINITION

• CARITAS – means love and charity.

- by nature is unconditional love.
- fundamental motive of Caring Science.
- from the ideas of caritas, Eriksson derived her whole
caritative caring theory.
• CARING COMMUNION – constitutes the meaning of caring and
the structure that determines reality.
- characterized by intensity and vitality and by warmth,
closeness, rest, respect, honesty and tolerance.
- requires meeting in time and space, an absolute lasting
presence.
- joining in communion means creating possibilities for the
other.
• THE ACT OF CARING – i

• CARITATIVE CARING ETHICS

– comprises the ethics of caring, the core of
which is determined by the caritas motive.
- Ethical Caring is what we actually make
explicit through our approach and the things
we do for the patient in practice.
• DIGNITY
– A human being’s absolute dignity involves the
right to be confirmed as a unique human being.

• INVITATION
– refers to the act that occurs when the carer
welcomes the patient to the caring communion.
• SUFFERING – is an ontological concept described as a human
being’s struggle between good and evil in the state of becoming.
- Suffering related to illness is experienced in
connection with illness and treatment.
- Suffering related to care is when the patient is
exposed to suffering caused by care or absence of caring.
- Suffering related to life is when you are being in a
situation of being a patient the entire life of a human being may
be experienced as suffering related to life.

• THE SUFFERING HUMAN BEING – is the concept that Eriksson

uses to describe a patient.
• RECONCILIATION – refers to the drama of
suffering.
- having achieved reconciliation implies living
with imperfection with regard to oneself and others
but seeing a way forward and a meaning in one’s
suffering.

• CARING CULTURE – is the concept that

Eriksson uses instead of environment.
- It characterizes the total caring reality and is
based on cultural elements such as traditions ,
rituals, and basic values.
 MAJOR ASSUMPTIONS

• Axioms - fundamental truths in

relation to the conception of the
world.

• Theses - are fundamental statements

concerning the general nature of
caring science and their validity
is tested through basic research.
Axioms

• The human being is fundamentally an entity of the body,

soul and spirit.

• The human being is fundamentally a religious being.

• The human being is fundamentally holy. Human dignity

means accepting the human obligation of serving with love,
of existing for the sake of others.

• Communion is the basis for all humanity. Human beings

are fundamentally interrelated to an abstract and/or
concrete other in a communion.
• Caring is something human by nature, a call
to serve in love.

• Suffering is an inseparable part of life,

suffering and health are each others
prerequisite.

• Health is more than the absence of illness.

Health implies wholeness and holiness.

• The human being lives in a reality that is

characterized by mystery, infinity and
eternity.
Theses

• Ethos confers ultimate meaning on the caring

context.

• The basic motive of caring is the caritas

motive.

• The basic category of caring is suffering.

• Caring communion forms the context of

meaning of caring and derives its origin from
the ethos of love, responsibility, and sacrifice
namely caritative ethics.
• Health means a movement in becoming, being,
and doing while striving for wholeness and
holiness which is compatible with endurable
suffering.

• Caring implies alleviation of suffering in charity,

love, faith, and hope. Natural basic caring is
expressed through tending, playing, and
learning in a sustained caring relationship,
which is asymmetrical in nature.