Naga College Foundation, Inc.

College of Health Sciences

NURSING THEORETICAL WORKS

MODULE 2

JOHANNA MARIA DJ. CASTILLO, RN, MN

Clinical Instructor
Course Code: NCM 100

Course Title: Theoretical Foundations in Nursing

Credit Units: 3 units lecture (54 hours)

Prerequisite: NONE

Duration: 1st Semester S/Y 2020-2021

Delivery Mode: Blended

Course Description:

This course deals with the meta- concepts of person, health, environment, and
nursing as viewed by the different theorists. Likewise, it includes non-nursing theories sub
systems, developmental and change theories. It presents how these concepts and theories
serve as guide in nursing practice. It further deals with health as multi factorial phenomenon
and necessary core competencies that the nurse need to develop.

Learning Objectives:

By the end of the lecture, students will be able to:

 Describe the various non-nursing theories as applied to nursing.

 Utilize selected nursing theories and non-nursing theories in the care of clients.

Learning Plan:

Schedule Description Time Frame

Invitation to join the Google Classroom

A. Write your expectation in Nursing Philosophies.

4 hrs/meeting
Week 2 B. Nursing Philosophies
1. Nightingale’s environmental theory Total: 8 hrs
2. Watson’s Theory of Human becoming
3. Benner’s stages of Nursing Expertise Nursing
Philosophies
4. Erikson’s Carative Caring Theory
Pre Test:

Matching Type:

____1. Florence Nightingale A. Caritative Caring Theory

____2. Jean Watson B. Theory of Human Caring

____3. Patricia Benner C. Environmental Theory

____4. Katie Eriksson D. Stages of Nursing Expertise Nursing

Philosophies

Lesson Proper

Theory of Florence Nightingale

Introduction
 Born - 12 May 1820
 Founder of mordern 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

Assumpations 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, Noise
3. Cleanliness of rooms/walls
4. Health of houses
5. Bed and bedding
6. Personal cleanliness
 7. Variety
8. Chattering hopes and advices
9. Taking food. What food?
10.Petty management/observation

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 is different from medicine and the goal of nursing is to place the patient in
the best possible condition 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 dys-ease 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 founation to nursing.
 Her thoghts have influenced nursing significantly.

Jean Watson's Philosophy of Nursing

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. A science of caring is complementary
to the science of curing.
7. The practice of caring is central to nursing.
The ten primary carative factors
1. The formation of a humanistic- altruistic system of values.
2. The installation of faith-hope.
3. The cultivation of sensitivity to one’s self and to others.
4. The development of a helping-trust relationship
5. The promotion and acceptance of the expression of positive and negative feelings.
6. The systematic use of the scientific problem-solving method for decision making
7. The promotion of interpersonal teaching-learning.
8. The provision for a supportive, protective and /or corrective mental, physical, socio-
cultural and spiritual environment.
9. Assistance with the gratification of human needs.
10.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:
o Congruence
o Empathy
o 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 eternal 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)
o The need for food and fluid
o The need for elimination
o The need for ventilation
 Lower order needs (psychophysical needs)
o The need for activity-inactivity
o The need for sexuality
 Higher order needs (psychosocial needs)
o The need for achievement
o The need for affiliation
o Higher order need (intrapersonal-interpersonal need)
o 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:
o A high level of overall physical, mental and social functioning
o A general adaptive-maintenance level of daily functioning
o 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
1. Logical in nature.
2. Relatively simple
3. Generelizable
4. Based on phenomenological studies that generally ask questions rather than state
hypotheses.
5. Can be used to guide and improve practice.
6. 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.
 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 practised, 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.
Martin, L. S. (1991). Using Watson’s theory to explore the dimensions of adult polycystic
kidney disease . ANNA Journal, 18, 403-406 .
Mullaney, J. A. B. (2000). The lived experience of using Watson’s actual caring occasions
to treat depressed women . Journal of Holistic Nursing, 18(2), 129-142
Martin, L. S. (1991). Using Watson’s theory to explore the dimensions of adult polycystic
kidney disease . ANNA Journal, 18, 403-406

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.

Patricia Benner’s From Novice to Expert

Introduction
 Dr Patricia Benner introduced the concept that expert nurses develop skills and
understanding of patient care over time through a sound educational base as well
as a multitude of experiences.
 She proposed that one could gain knowledge and skills ("knowing how") without
ever learning the theory ("knowing that").
 She further explains that the development of knowledge in applied disciplines such
as medicine and nursing is composed of the extension of practical knowledge (know
how) through research and the characterization and understanding of the "know
how" of clinical experience.
 She coneptualizes in her writing about nursing skills as experience is a prerequisite
for becoming an expert.

ABOUT THE THEORIST

 Patricia E. Benner, R.N., Ph.D., FAAN is a Professor Emerita at the University of
California, San Francisco.
 BA in Nursing - Pasadena College/Point Loma College
 MS in Med/Surg nursing from UCSF
 PhD -1982 from UC Berkeley
 1970s - Research at UCSF and UC Berkeley
 Has taught and done research at UCSF since 1979
 Published 9 books and numerous articles
 Published ‘Novice to Expert Theory’ in 1982
 Received Book of the Year from AJN in 1984,1990,1996, 2000
 Her web address is at: http://www.PatriciaBenner.com
 Her profile can be obtained at http://nurseweb.ucsf.edu/www/ix-fd.shtml
LEVELS OF NURSING EXPERIENCE
She described 5 levels of nursing experience as;
 1. Novice
2. Advanced beginner
3. Competent
4. Proficient
5. Expert
Novice
 Beginner with no experience
 Taught general rules to help perform tasks
 Rules are: context-free, independent of specific cases, and applied universally
 Rule-governed behavior is limited and inflexible
 Ex. “Tell me what I need to do and I’ll do it.”
Advanced Beginner
 Demonstrates acceptable performance
 Has gained prior experience in actual situations to recognize recurring meaningful
components
 Principles, based on experiences, begin to be formulated to guide actions
Competent
 Typically a nurse with 2-3 years experience on the job in the same area or in
similar day-to-day situations
 More aware of long-term goals
 Gains perspective from planning own actions based on conscious, abstract, and
analytical thinking and helps to achieve greater efficiency and organization
Proficient
 Perceives and understands situations as whole parts
 More holistic understanding improves decision-making
 Learns from experiences what to expect in certain situations and how to modify
plans
Expert
 No longer relies on principles, rules, or guidelines to connect situations and
determine actions
 Much more background of experience
 Has intuitive grasp of clinical situations
 Performance is now fluid, flexible, and highly-proficient
Different levels of skills reflect changes in 3 aspects of skilled performance:
1. Movement from relying on abstract principles to using past concrete experiences to
guide actions
2. Change in learner’s perception of situations as whole parts rather than in separate
pieces
3. Passage from a detached observer to an involved performer, no longer outside the
situation but now actively engaged in participation
SIGNIFICANCE OF THE THEORY
 These levels reflect movement from reliance on past abstract principles to the use
of past concrete experience as paradigms and change in perception of situation as a
complete whole in which certain parts are relevant
 Each step builds on the previous one as abstract principles are refined and
expanded by experience and the learner gains clinical expertise.
 This theory changed the profession's understanding of what it means to be an
expert, placing this designation not on the nurse with the most highly paid or most
prestigious position, but on the nurse who provided "the most exquisite nursing
care.
 It recognized that nursing was poorly served by the paradigm that called for all of
nursing theory to be developed by researchers and scholars, but rather introduced
the revolutionary notion that the practice itself could and should inform theory.

CONCLUSION
 Nursing practice guided by the human becoming theory live the processes of the
Parse practice methodology illuminating meaning, synchronizing rhythms, and
mobilizing transcendence
  Research guided by the human becoming theory sheds light on the meaning of
universal humanly lived experiences such as hope, taking life day-by-day, grieving,
suffering, and time passing

RESEARCH ON BENNER'S THEORY

1. Towards an alternative to Benner's theory of expert intuition in nursing: a
discussion paper
2. An evaluation of the seminal work of Patricia Benner: theory or philosophy?
3. A response by P. Benner to K. Cash, "Benner and expertise in nursing: a critique"
4. Benner and expertise in nursing: a critique
5. Intuition as a function of the expert nurse: a critique of Benner's novice to expert
model

Katie Eriksson

 Theory of Carative Caring

 “Caritative nursing 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 exists’ […] Caring communion, true caring, occurs when the one caring in
a spirit of caritas alleviates the suffering of the patient.”
 The ultimate goal of caring is to lighten suffering and serve life and health.
 Inspired many in the Nordic countries, and used as the basis of research,
education, and clinical practice.

Activities

1. Discuss and give example of the 13 cannons by Florence Nightingale.

2. Discuss and differentiate Benner’s Theory of Novice to Expert.

Post Test

Matching Type:

____1. Florence Nightingale A. Caritative Caring Theory

____2. Jean Watson B. Theory of Human Caring

____3. Patricia Benner C. Environmental Theory

____4. Katie Eriksson D. Stages of Nursing Expertise Nursing

Philosophies
Answer

References:

1. Dracup and Bryan-Brown. From Novice to Expert to Mentor Shaping the Future -
American Journal of Critical Care. 2004;13: 448-450.
2. Jane Corrigan Wandel. The Institute for Nursing Healthcare Leadership Conference:
Reflections on the Impact of Patricia Benner's Work. Medscape Nurses. 2003;5(2).
Accessed on 5-04-2010 from http://www.medscape.com/viewarticle/462607
3. Timber BK. Fundamental skills and concepts in Patient Care, 7th edition, LWW, New
Yok.
4. George B. Julia , Nursing Theories- The base for professional Nursing Practice , 3rd
ed. Norwalk, Appleton & Lange.
5. Nightingale, F. Notes on nursing: What it is and what it is not. 1860.
6. Works by Florence Nightingale at Project Gutenberg
7. Selanders LC. The power of environmental adaptation: Florence Nightingale's
original theory for nursing practice. .J Holist Nurs. 2010 Mar; 28(1):81-8.