Theoretical Foundations in Nursing
Module 2
LESSON TITLE:
▪ FLORENCE NIGHTINGALE’S ENVIRONMENTAL THEORY
▪ JEAN WATSON’S PHILOSOPHY & THEORY OF
TRANSPERSONAL CARING
LEARNING TARGETS:
1. Discuss the life of Florence Nightingale as a person & as a nurse;
2. Define the philosophy of nursing according to the view of Nightingale;
3. Describe relevant situations where Nightingale’s theory can be practically
applied;
4. Identify the significant contributions of Nightingale to the nursing
profession;
5. Familiarize key points of credentials and background of theorist Jean
Watson;
6. Define the philosophy of nursing according to the view of Watson;
7. Describe the ten clinical processes; and,
8. Integrate Watson’s theory in the nursing practice.
Nursing Philosophies
sets for the meaning of nursing phenomena
through analysis, reasoning and logical
argument. Are works that provide broad
understanding that advances the discipline and
its professional application.
The history of nursing theory was
dated way back when Florence
Nightingale began to assume the
great significance of providing a
clean and healthy environment to
achieve faster recovery of patients
and continues up to present.
FLORENCE NIGHTINGALE
➢ 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.
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
➢ 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 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 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
The person is the patient himself. Patients are the
Person 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 as
a person who needed nursing care regardless of the
patient’s social worth
Nightingale viewed health as being well. Health is also
Health 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 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
The environment was viewed as “those elements
external to and which affect the health of the sick
Environment and healthy person” and included “everything from
the patient’s food and flowers to the patient’s verbal
and 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:
➢ Nursing Practice: Ventilation, warmth, quiet, diet, and cleanliness
are still important aspects of nursing care. We, nurses, thus need
to maintain adequate ventilation, promote adequate and
appropriate nutrition, maintain normal homeostatic body
temperature, and observe basic hygiene and comfort measures,
including environmental sanitations.
➢ Nursing Education: 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 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
➢ Nursing Research: Nightingale is considered the mother of nursing
research because of her interest in the scientific methods of
inquiry and statistics. She was able to gather and analyze data
efficiently and resourcefully. She was the first to use polar
diagrams in presenting study data. The concepts of Nightingale’s
theory still serve as a basis for current research. In the 1990s,
research studies that tested and expanded nursing theory were
numerous.
WATSON'S PHILOSOPHY & THEORY OF
TRANSPERSONAL CARING
“Nursing is the human science of
persons and human health – illness
experiences that are mediated by
professional, personal, scientific,
aesthetic, and ethical human care
transactions.”
JEAN WATSON
v born and grew up in a small town of Welch West Virginia; youngest of the
eight children
v began developing her theory while she was assistant dean of the
undergraduate program at University of Colorado
v in 1978-1981, she served as coordinator and director of the PhD program
v worked from 11 curative factors to formulate her 10 carative factors
v modified 10 factors slightly over time and developed the caritas processes,
which have a spiritual dimension and use a more fluid and evolutionary
language
v authorized 11 books which reflect the evolution of her theory of caring
➢ 1st book – Nursing: The Philosophy and Science of Caring
(1979), use 10 carative factors but evolved to include “caritas”
(connection between caring and love)
➢ 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
Humanistic-altruistic system of Practice of loving kindness and equanimity (self-
value control/composure) within context of caring
consciousness.
Faith-hope Being authentically present, and enabling and sustaining
the deep belief system and subjective life world of self
and the one-being-cared-for
Sensitivity to self and others Cultivation of one’s own spiritual practices and
transpersonal self, going beyond ego self, opening to
others with sensitivity and compassion.
CARATIVE FACTORS CLINICAL PROCESSES
Helping-trusting, human care Developing and sustaining a helping-trusting, authentic
relationship caring relationship
Expressing positive and Being present to, and supportive of, the expression of
negative feelings positive and negative feelings as a connection with a
deeper spirit of self and the one-being-cared-for
Creative problem-solving Creative use of self and all ways of knowing as part of
caring process the caring process to engage in artistry of caring-healing
practices.
CARATIVE FACTORS CLINICAL PROCESSES
Transpersonal teaching- Engaging in genuine teaching-learning experience that
learning attends to unity of being and meaning, attempting to
stay within other’s frames of reference.
Supportive, protective, and/or Creating a healing environment at all levels (physical as
corrective mental, physical, well as non-physical), subtle environment of energy and
societal, and spiritual consciousness, whereby wholeness, beauty, comfort,
environment dignity, and peace are potentiated.
CARATIVE FACTORS CLINICAL PROCESSES
Human needs assistance Assisting with basic needs, with an intentional caring
consciousness, administering “human care essentials”,
which potentiate alignment of mind-body-spirit,
wholeness, and unity of being in all aspects of care,
tending to both the embodied spirit and evolving
spiritual emergence.
Existential-phenomenological- Opening and attending to spiritual-mysterious and
spiritual forces existential dimensions of one’s own life-death; soul
care for self and the one-being-cared-for
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
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 –
Nursing illness experiences that are mediated by professional,
personal, scientific, aesthetic, and ethical human care
transactions.
Personhood (human being)
➔ a unity of mind/body/spirit/nature
➔ Unitary Transformative Paradigm-Holographic thinking:
Person
“…unity within an evolving emergent world view-
connectedness of all…”
➔ three words: Mind, Body, Soul
➔ “… humans cannot be treated as objects and that
humans cannot be separated from self, other, nature,
and the larger universe.”
➔ “…illness is not necessarily disease; [instead it is
Health
a] subjective turmoil or disharmony within the
spheres of the 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
Environment
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 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:
➔ Nursing Practice (Administration & Leadership): 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.
Application to Nursing:
➔ Nursing Education: 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.
Application to Nursing:
➔ Nursing Research: 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.
Implications of the Theory:
➔ One major implication of the theory is in the realm of bedside nursing
where nurses of today have particularly begun to neglect. The
essence of nursing is in the caring aspect and caring is taking the
wholeness, the totality, of the patient in consideration.
➔ More importantly, nurses of today should try to care for a patient for
who he is. After all, all of us were created equal and in His likeness.
Reference: Alligood, M. (2018). Nursing theories and their work (9 th ed.).
Singapore: Elsevier.