Theoretical Foundations

in Nursing
John Marco L. Segobre RN, MAN, MHA (in progress)
Florence Nightingale’s Environmental Theory
● Florence Nightingale was born on May 12,
1820
● Much attention has been to the “Calling” that
Nightingale recorded in her diary in 1837, when
she wrote that “ God spoke to me and called
me to his service”.
● Florence Nightingale began her nursing training
in 1851 in Kaiserswerth, Germany.
Florence Nightingale’s Environmental Theory

✔ Nightingale’s (1859-1992) Notes on Nursing presents

the nursing theory that focuses on the manipulation of the
environment for the benefits of the patient.
✔ Although Nightingale did not present her work as a
nursing theory, it has directed nursing practice for over
140 years. She is known as the Mother of Modern
Nursing.
✔ Daughter of William Nightingale of Embley Park,
Hampshire and was born in Italy, on the 12th day of May,
1820.
The Crimean War
In March 1853, the Crimean War broke out
between Russia and Turkey. It was during this war
where Florence Nightingale volunteered her
services and was eventually given permission to
take a group of 38 nurses to Turkey.
The Crimean War
She found the conditions as:
● soldiers lay in filth straw pallets in crowded hallways
● rats and insects crawled the floors and walls
● hospitals lack basic supplies, such as cots, mattresses,
bandages, washbasins, soap, and towels
● water was rationed, and available in totally inadequate
amounts
● wounded armies were wearing unwashed uniforms
that were stiff with dirt and gore
● diseases such as typhus, cholera, and dysentery were
the primary reasons why the death rate was high
The Crimean War

● She recognized that overcrowding, filth, and

poor ventilation all contributed to the illness of
the soldiers.
● At night, she carried a lamp through the
corridors, stopping to help the suffering of the
wounded soldiers, for this, she was nicknamed,
“The Lady with the Lamp”
Post-War Contributions

➔ Nightingale returned to England as a national

heroine in 1856
➔ She published two books: Notes on Hospital (1859)
and Notes on Nursing (1859)
➔ She raised enough funds and used this to establish
the Nightingale School and Home for Nurses at St.
Thomas Hospital.
➔ Nightingale’s work greatly influenced John Stuart
Mill’s book on women’s rights.
ENVIRONMENTAL THEORY
“Nursing is the art of utilizing the
patient’s environment for his or her
recovery.”
Environment – defined as the external
conditions and influences affecting the life
and development of an organism and
capable of preventing, suppressing, or
contributing to disease, accidents, or
deaths.
Components of Environment:
● Proper Ventilation. Nightingale believed that nurses have
the responsibility to keep the air that the patient breathes
pure as the external air without necessarily chilling him. She
recognized the possibility that inadequate ventilation may be
the source of disease.

● Adequate Light. Direct sunlight has quite as real and

tangible effects on the human body who has not observed
the purifying effect of light, and especially of direct sunlight.

● Cleanliness. She advocated taking a bath daily and that

nurses should also bathe daily while keeping their duty
uniforms clean and their hands washed clean.
● Warmth. Nightingale outlined a procedure for measuring the
body’s temperature through palpation of, or feeling for the
extremities in order to assess for heat loss. One of the nurse’s
role is to manipulate the environment. Positioning the patient,
opening the windows, and regulating the room temperature
are ways of maintaining this balance.
● Quiet. Nightingale described unnecessary noise can actually
be harmful to the patient who is ill.
● Diet. Nightingale maintained that one of the nurse’s role is to
assess both the meal schedule and its effect on the patient, in
addition to assessing the patient’s dietary intake.
Management. The nurse is actually in control of the
environment, physically, and administratively. The nurse is
responsible for controlling the environment so that the patient
is protected from physical and psychological harm.
Theory in View of Metaparadigms:
Nightingale’s view of nursing was comparable to that of
motherly instincts. She believed that every woman would
be a nurse because nursing is having the responsibility
for someone else’s health – a characteristic shared by
women, especially mothers. Her “Notes On Nursing”
provided guidelines to women who wanted to become
nurses and gave advice on how to think like a nurse.
Nursing is a vocation that needs formal learning and
Nursing application of scientific principles in the care of patients.
Nursing personnel were thus having more skill in terms of
assessment and reporting of the patient’s health status.
At the same time, the nurse is also able to perform
nursing interventions that will allow the patient to heal and
recover.
Theory in View of Metaparadigms:
The person is the patient himself. Patients are
the recipient of our care. A passive patient is
a patient who depends wholly on the nurse for
tasks and control of his environment. The
nurse is totally in control of the patient and his
environment. Nightingale viewed the patient
Person as a person who needed nursing care
regardless of the patient’s social worth.
Theory in View of Metaparadigms:
Nightingale viewed health as being well.
Health is also living up to one’s potential to
the fullest extent. Disease and illness are
viewed as reparative processes that are
instituted by Mother Nature herself when the
Health
person did not attend to his personal health
concerns. Nightingale emphasized the
promotion and maintenance of health and
prevention of diseases through prudent
control of the environment and social
responsibility.
Theory in View of Metaparadigms:
The environment was viewed as “those
elements external to and which affect the
health of the sick and healthy person” and
included “everything from the patient’s food
and flowers to the patient’s verbal and
Environment nonverbal interactions.” Central to
Nightingale’s theory is the concept of a
therapeutic environment that will enhance
the comfort and recovery of the patient.
Application to Nursing:
Ventilation, warmth, quiet, diet, and cleanliness are
still important aspects of nursing care. We, nurses,
thus need to maintain adequate ventilation, promote
Nursing Practice: adequate and appropriate nutrition, maintain normal
homeostatic body temperature, and observe basic
hygiene and comfort measures, including
environmental sanitations.

Nightingale had established the St. Thomas Hospital

and King’s College Hospital in London, which was
able to provide a framework for the establishment of
nursing training schools through a universal template
Nursing Education: that contains principles of nursing training. She also
advocated the separation of nursing training from the
hospital to a more appropriate learning environment
in the school or university setting.
Application to Nursing:
Nightingale had established the St. Thomas
Hospital and King’s College Hospital in London,
which was able to provide a framework for the
establishment of nursing training schools through
Nursing Research: a universal template that contains principles of
nursing training. She also advocated the
separation of nursing training from the hospital to
a more appropriate learning environment in the
school or university setting.
Check for Understanding
2. Florence Nightingale defined Nursing as:
a.Manipulation of the environment for the
benefits of the patient.
b.Relationship between nurse and the
patient
c.Nursing is the art of utilizing the patient’s
environment for his or her recovery.
d.Nursing is the art of caring for the patient
to achieve fast recovery.
WATSON'S PHILOSOPHY & THEORY OF
TRANSPERSONAL
“Nursing is the humanCARING
science of persons and human health
– illness experiences that are mediated by professional,
personal, scientific, aesthetic, and ethical human care
transactions.”
JEAN WATSON
✔ Born and grew up in a small town of Welch West Virginia; youngest of
the eight children
✔ Began developing her theory while she was assistant dean of the
undergraduate program at University of Colorado
✔ In 1978-1981, she served as coordinator and director of the PhD
program
✔ Worked from 11 curative factors to formulate her 10 carative factors
JEAN WATSON
Modified 10 factors slightly over time and developed the caritas processes,
which have a spiritual dimension and use a more fluid and evolutionary
language
✔ Authorized 11 books which reflect the evolution of her theory of caring
o 1st book – Nursing: The Philosophy and Science of Caring
(1979), use 10 carative factors but evolved to include “caritas”
(connection between caring and love)
o 2nd book – Nursing: Human Science and Human Care – A Theory
of Nursing (1985), addressed her conceptual and philosophical
problem in nursing
Transpersonal Caring Relationship
● Foundational of her theory; it is a special kind of human care
relationship
● A union with another person-high regard for the whole
person and their being in the world
● “Caritas” originates from the Greek vocabulary, meaning to
cherish and to give special loving attention
● Watson uses the term “carative” instead of curative
10 Elements of Carative Factors:
CARATIVE FACTORS CLINICAL PROCESSES

Practice of loving kindness and equanimity (self-

Humanistic-altruistic control/composure) within context of caring
system of value consciousness.

Being authentically present and enabling and

sustaining the deep belief system and subjective
Faith-hope life world of self and the one-being-cared-for.
10 Elements of Carative Factors:
CARATIVE FACTORS CLINICAL PROCESSES

Cultivation of one’s own spiritual practices and

Sensitivity to self and transpersonal self, going beyond ego self, opening
others to others with sensitivity and compassion.

Developing and sustaining a helping-trusting,

Helping-trusting, authentic caring relationship.
human care
relationship
10 Elements of Carative Factors:
CARATIVE FACTORS CLINICAL PROCESSES

Being present to, and supportive of, the

Expressing positive expression of positive and negative feelings as a
and negative feelings connection with a deeper spirit of self and the one-
being-cared-for.
Creative use of self and all ways of knowing as
Creative problem- part of the caring process to engage in artistry of
solving caring process caring-healing practices.
10 Elements of Carative Factors:
CARATIVE FACTORS CLINICAL PROCESSES

Transpersonal Engaging in genuine teaching-learning experience

teaching-learning that attends to unity of being and meaning,
attempting to stay within other’s frames of
reference.
Supportive, protective, Creating a healing environment at all levels
and/or corrective (physical as well as non-physical), subtle
mental, physical, environment of energy and consciousness,
societal, and spiritual whereby wholeness, beauty, comfort, dignity, and
environment peace are potentiated.
10 Elements of Carative Factors:
CARATIVE FACTORS CLINICAL PROCESSES

Assisting with basic needs, with an intentional caring

consciousness, administering “human care
Human needs essentials”, which potentiate alignment of mind-body-
assistance spirit, wholeness, and unity of being in all aspects of
care, tending to both the embodied spirit and evolving
spiritual emergence.

Opening and attending to spiritual-mysterious and

Existential-
existential dimensions of one’s own life-death; soul
phenomenological- care for self and the one-being-cared-for.
spiritual forces
Transpersonal Caring Relationship
Characterizes a special kind of human care relationship that depends on:
● The nurse’s moral commitment in protecting and enhancing human
dignity as well as the deeper/higher self
● The nurse’s caring consciousness communicated to preserve and
honor the embodied spirit, therefore, not reducing the person to the
moral status of an object
● The nurse’s caring consciousness and connection having the
potential to heal since experience, perception, and intentional
connection are taking place
Transpersonal Caring Relationship
The term “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. Finally, the goal of a
transpersonal relationship corresponds to protecting, enhancing, and
preserving the person’s dignity, humanity, wholeness, and inner harmony
Transpersonal Caring Relationship
A caring occasion is the moment (focal point in space and time) when
the nurse and another person come together in such a way that an
occasion for human caring is created. Assistance with the gratification of
human needs describes the role of the nurse in promoting wellness and
health through the achievement of basic human needs according to
Maslow’s hierarchy of needs.
Theory Assertions
✔ The theory acknowledges the unity of the person’s mind-body-spirit.
✔ The mind is the point of access to the body and the spirit.
✔ The spirit relates to a person’s soul, the inner self, the essence of the
person, the spiritual self.
✔ It is the spirit that allows the person to transcend the “here and now”
coexisting with past, present, and future, all at once through creative
imagination and visualization.
✔ Watson ascertains that the care of the soul remains the most powerful
aspect of the art of caring in nursing.
Major Assumptions
● Nurse’s ability to connect with another at this transpersonal spirit to spirit level is
translated via means of communication, into nursing human art and acts or intentional
caring- healing modalities.
● Caring-healing modalities within the context of transpersonal caring/ caritas
consciousness potentiate harmony, wholeness and unity of being by releasing some of
the disharmony.
● Ongoing personal & professional development and spiritual growth.
● Nurse’s own life history, previous experiences etc. Are valuable teachers for this work.
● Other facilitators are personal growth experiences such as psychotherapy and other
models for spiritual awakening.
● Continuous growth for developing and maturing within a transpersonal caring model is
ongoing.
Theory in View of Metaparadigms:
Nursing is the human science of persons and human health –
illness experiences that are mediated by professional,
Nursing personal, scientific, aesthetic, and ethical human care
transactions.

Personhood (human being)

● a unity of mind/body/spirit/nature
● Unitary Transformative Paradigm-Holographic thinking: “…unity
within an evolving emergent world view-connectedness of all…”
● three words: Mind, Body, Soul
Person ● “… humans cannot be treated as objects and that humans
cannot be separated from self, other, nature, and the larger
universe.”
Theory in View of Metaparadigms:
“…illness is not necessarily disease; [instead it is a]
subjective turmoil or disharmony within the spheres of the
Health person, for example, in the mind, body, and soul, either
consciously or unconsciously.”

Society – provides the values that determine how one should behave
and what goals one should strive toward. Watson stated, “Caring
(and nursing) has existed in every society. Every society has had
some people who have cared for others. A caring attitude is not
Environment transmitted from generation to generation by genes. It is transmitted
by the culture of the profession as a unique way of coping with its
environment.”
Application to Nursing:
It calls for administrative practices and embrace caring, even in a health care environment of
increased acuity levels of hospitalized individuals, short hospital stays, increasing complexity of
technology, and rising expectations in the task of nursing.
Nursing Practice:

Watson’s writings focus on educating graduate nursing students and providing them with
ontological, ethical, and epistemological bases for their practice, along with research directions.
Watson’s caring framework has been taught in numerous baccalaureate nursing curricula.
Nursing Education:

Watson’s theory to reduce distress experienced by infertile women. Her theory and the application
of theory of clinical practice hospital organizations have been their major weakness of research.
Nelson and Watson report on studies carried out in seven countries.
Nursing Research:
Check For Understanding:
1. One concept Watson defined is transpersonal caring which
means?
a.to go beyond one’s own choices and the others and now
b.to go beyond one’s own ego and the here and now
c.unity and harmony within the mind, body, and soul
d.unity and harmony within the mind, body, and spirit
Check For Understanding:
2. The theory of Jean Watson constitutes the carative factors
turned into clinical processes. Which of the following are the
carative factors, except?
a. Transpersonal teaching and learning
b. Helping-trusting, human care relationship
c. Insensitivity to self and others
d. Faith-hope