ADVANCED

PHILOSOPHICAL
THEORY FOUNDATIONS
IN NURSING

by:
Marie John C. Jardiolin RN.
FLORENCE NIGHTINGALE
“Environmental Theory”
• Crimean War
• "The Lady with the Lamp"
• ‘ministering angel’
• Nightingale School
Crimean War
 Nightingale's lasting
contribution has been
her role in founding the
modern nursing
profession. She set an
example of
compassion,
commitment to patient
care, and diligent and
thoughtful hospital
administration.
Three Components of Environmental
Theory of Nightingale

1. PHYSICAL ENVIRONMENT

• Consists of physical elements where the patient is

being treated

• Affects all other aspects of the environment

• Cleanliness of environment relates directly to

disease prevention and patient mortality

• Aspects of the physical environment  influence the

social and psychological environments of the person
2. PSYCHOLOGICAL ENVIRONMENT

• Can be affected by a negative physical environment

which then causes STRESS

• Requires various activities to keep the mind active

(i.e, manual work, appealing food, a pleasing
environment)

• Involves communication with the person, about the

person, and about other people

• Communication should be therapeutic, soothing, &

unhurried!
3. SOCIAL ENVIRONMENT

• Involves collecting data about illness and disease

prevention

• Includes components of the physical environment -

clean air, clean water, proper drainage

• Consists of a person’s home or hospital room, as well

as the total community that affects the patient’s specific
environment
The Advantage of the
Theory to HEALTH

1. Maintained by using a person’s healing powers to their

fullest extent
2. Maintained by controlling the environmental factors so
as to prevent disease
3. Disease is viewed as a reparative process instituted by
nature
4. Health & disease are the focus of the nurse
5. Nurses help patients through their healing process
Nightingale’s Theory and Nursing’s
Metaparadigm - NURSING
1. Provides fresh air, light, warmth, cleanliness, quiet, and a
proper diet
2. Facilitates a patient’s reparative process by ensuring the best
possible environment
3. Influences the environment to affect health
4. Supports the nursing process (even though it was not even
developed yet!)
5. Nursing education belongs in the hands of nurses!
6. Nursing is a discipline distinct from medicine focusing on the
patient’s reparative process rather than on their disease!!
Jean Watson
“Theory of Caring”
 The Seven Assumptions
Watson proposes seven assumptions about the science of caring.
The basic assumptions are:
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
The structure for the science of caring is built upon ten carative
factors. These are:

1. The formation of a humanistic- 7. The promotion of interpersonal

altruistic system of values. teaching-learning.

2. The installation of faith-hope.

8. The provision for a supportive,
protective and /or corrective
3. The cultivation of sensitivity to mental, physical, socio-cultural
one’s self and to others. and spiritual environment.

4. The development of a helping-

trust relationship
5. The promotion and acceptance
of the expression of positive
and negative feelings.
9. Assistance with the
gratification of human needs.
10. The allowance for existential-
phenomenological forces.

6. The systematic use of the

scientific problem-solving
method for decision making
 Watson’s Theory &
The Four Major Concepts
1.     Human being
She adopts a view of the human being as:  “….. 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 believes that there are other factors that are needed to be included
in the WHO definition of health. She adds the following three elements:

• 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)
 Watson’s Theory &
The Four Major Concepts
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
According to Watson, “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”. 
Virginia Henderson

“Need theory”
 “Nursing theories mirror different realities, throughout their
development; they reflected the interests of nurses of that time.”

Henderson’s concept of nursing was derived from her practice

and education therefore, her work is inductive. She called her
definition of nursing her “concept”.

Although her major clinical experiences were in medical-

surgical hospitals, she worked as a visiting nurse in New York City.
This experience enlarges Henderson’s view to recognize the
importance of increasing the patient’s independence so that
progress after hospitalization would not be delayed .
• Defined nursing as "assisting individuals to gain independence in
relation to the performance of activities contributing to health or its
recovery”.

• One of the first nurses to point out that nursing does not consist of
merely following physician's orders.

• Categorized nursing activities into 14 components, based on human

needs. 

• Described the nurse's role as Substitutive (doing for the person),

Supplementary (helping the person), Complementary (working with
the person), with the goal of helping the person become as
independent as possible.
• Her famous definition of nursing was one of the first statements
clearly delineating nursing from medicine.

“The unique function of the nurse is to assist the individual,

sick or well, in the performance of those activities contributing
to health or its recovery (or to peaceful death) that he would
perform unaided if he had the necessary strength, will or
knowledge.  And to do this in such a way as to help him gain
independence as rapidly as possible”.
 The Development of Henderson’s
Definition of Nursing
Two events are the basis for Henderson’s development of a
definition of nursing.

1. First, she participated in the revision of a nursing textbook.

2. Second, she was concerned that many states had no provision
for nursing licensure to ensure safe and competent care for the
consumer.

In the revision she recognized the need to be clear about the

functions of the nurse and she believed that the textbook serves
as a main learning source for nursing practice should present a
sound and definitive description of nursing.
• Furthermore, the principles and practice or nursing must be built
upon and derived from the definition of the profession.

• Although official statements on the nursing function were published

by the ANA in 1932 and 1937, Henderson viewed these statements
as nonspecific and unsatisfactory definitions of nursing practice.

• Then in 1955, the earlier ANA definition was modified.

• Henderson's focus on individual care is evident in that she stressed

assisting individuals with essential activities to maintain health, to
recover, or to achieve peaceful death.

• She proposed 14 components of basic nursing care to augment her

definition.

• In 1955, Henderson’s first definition of nursing was published in

Bertha Harmer’s revised nursing textbook.
Henderson’s Theory and the
Four Major Concepts

Individual
Environment
Health
Nursing
 Individual
• Have basic needs that are component of health.
• Requiring assistance to achieve health and independence or
a peaceful death.
• Mind and body are inseparable and interrelated.
• Considers the biological, psychological, sociological, and
spiritual components.
• The theory presents the patient as a sum of parts with
biopsychosocial needs, and the patient is neither client nor
consumer.
 Environment
• Settings in which an individual learns unique pattern for living.
• All external conditions and influences that affect life and
development.
• Individuals in relation to families
• Minimally discusses the impact of the community on the
individual and family.
• Supports tasks of private and public agencies
• Society wants and expects nurses to act for individuals who
are unable to function independently.
• In return she expects society to contribute to nursing
education.
• Basic nursing care involves providing conditions under which
the patient can perform the 14 activities unaided
 Health
• Definition based on individual’s ability to function
independently as outlined in the 14 components.

• Nurses need to stress promotion of health & prevention and

cure of disease.

• Good health is a challenge.

• Affected by age, cultural background, physical, and

intellectual capacities, and emotional balance

• Is the individual’s ability to meet these needs independently?

 Nursing
• Temporarily assisting an individual who lacks the necessary
strength, will and knowledge to satisfy 1 or more of 14 basic
needs.

• Assists and supports the individual in life activities and the

attainment of independence.

• Nurse serves to make patient “complete” “whole", or

"independent."
 Nursing
• The nurse is expected to carry out physician’s  therapeutic plan”

• Individualized care is the result of the nurse’s creativity in planning

for care.

• Use nursing research

• Categorized
 Nursing : nursing care
 Non nursing: ordering supplies, cleanliness and serving food.
 Nursing
• In the Nature of Nursing “that the nurse is and should be legally, an
independent practitioner and able to make independent judgments as
long as s/he is not diagnosing, prescribing treatment for disease, or
making a prognosis, for these are the physicians function.”

• “Nurse should have knowledge to practice individualized and human

care and should be a scientific problem solver.”

• Nurse role is, “to get inside the patient’s skin and supplement his
strength will or knowledge according to his needs.”

• And nurse has responsibility to assess the needs of the individual

patient, help individual meet their health need, and or provide an
environment in which the individual can perform activity unaided.
Henderson's Classic Definition
of Nursing:

"I say that the nurse does for others what

they would do for themselves if they had the
strength, the will, and the knowledge. But I
go on to say that the nurse makes the
patient independent of him or her as soon as
possible."
Henderson & Nursing Process
• Henderson views the nursing process as “really the
application of the logical approach to the solution of a
problem. The steps are those of the scientific method.”

• “Nursing process stresses the science of nursing rather

than the mixture of science and art on which it seems
effective health care service of any kind is based.”