NURSING

PHILOSOPHIES
AND CONCEPTUAL
MODELS
KRISTIAN JARIS PONCE, RN
Instructor, Theoretical Foundations of Nursing
FOUR CONCEPTS
OF NURSING
METAPARADIGM Person Environment

Health Nursing
 1. Nightingale’s
Environmental Theory

NURSING
2. Watson’s Theory Of
Human Caring
3. Benner’s Stages Of

PHILOSOPHIES Nursing Expertise

Nursing Philosophies
4. Eriksson’s Carative
Caring Nursing Theory
DESCRIBING PHILOSOPHIES

• Ideas
• Concepts
• Assumptions
• Answer broad questions
• Direct thoughts to moral obligations to society
• Contain ethical knowledge that is core value to nursing
FLORENCE
NIGHTINGALE
MAY 12, 1820 – AUGUST 13, 1910

• British nurse, writer, social

reformer, and statistician
• Founder of Modern Nursing
• Most notable work during the
Crimean War where she
observed and documented the
military mortalities and made
interventions to their physical
environment leading to
significant improvements
NIGHTINGALE’S
ENVIRONMENTAL
THEORY
• Emphasis on the physical
environment: “Pure air, pure water,
efficient drainage, cleanliness, and
light” as essential to health
• Ventilation
• Sunlight
• Cleanliness
• Disposal of body secretions
and sewage
• Regular bathing
• Healthy environment: essential to
healing
FLORENCE NIGHTINGALE: ENVIRONMENTAL
THEORY
METAPARADIGM ASSUMPTION
Environment Surroundings: Physical and psychological healthy and
unhealthy
Person Recipient of care comprised of physical, mental,
spiritual, and emotional components
Health Not only an absence of disease, but promotion of
physical fitness
Nursing Helping a person attain health through observations and
interventions based on knowledge (different from
medical knowledge and more than knowledge from
books)
JEAN WATSON

• American nurse theorist,

nursing professor, lecturer,
and writer
• Fuses science with
humanities
THEORY OF HUMAN CARING:
10 CARITAS PROCESSES
1. Sustaining Humanistic-Altruistic Values by Practicing Loving-
Kindness, Compassion, and Equanimity with Others
(Embrace)
2. Being Authentically Present; Enabling Fiath, Hope, and Belief
System; Honoring Subjective Inner, Life-World of Self
(Inspire)
3. Being Sensitive to Self and Others by Cultivating Own Spiritual
Practices, Beyond Ego-Self to Transpersonal Presence (Trust)
4. Development and Sustaining Loving, Trusting Relationships
(Nurture)
5. Allowing for Expression of Positive and Negative Feelings—
Listening Authentically to Another Person’s Story (Forgive)
THEORY OF HUMAN CARING:
10 CARITAS PROCESSES
6. Creative Problem-Solving – “Solution-Seeking” Through Caring
Process, Full Use of Self and Artistry of Caring-Healing Practices
via Use of All Ways of Knowing/Being/Doing/Becoming
(Deepen)
7. Engage in Transpersonal Teaching and Learning Within Context of
Caring Relationship, Staying Within Other’s Frame of Reference
(Balance)
8. Creating a Healing Environment at All Levels, a Subtle
Environment for Energetic, Authentic Caring Practice (Co-Create)
9. Revenrentially Assisting With Basic Needs as Sacred Acts,
Sustaining Human Dignity (Minister
10. Opening and Attending to the Spiritual, Mystery, Unknown,
Allowing for Miracles (Open)
JEAN WATSON: THEORY OF HUMAN CARING
METAPARADIGM ASSUMPTION
Environment Infinite universal spirit world of nature and all living things;
primordial link of humanity and life across time, space, boundaries,
and nationalities
Person Whole spiritual being fully connected and evolving towards the
Source with an infinite field of universal consciousness and Cosmic
Love
Cannot be treated as objects or separated from self, other, nature,
and larger universe
Health Unity and harmony within the mind, body, and spirit associated
with the degree of congruence between the self as perceived and the
self as expected
Nursing Knowledge, thought, values, philosophy, commitment, and action
with some degree of passion
PATRICIA
BENNER

• American nursing theorist,

academic, and author
 Novice – no background/experience, e.g. nursing
STAGES OF students or nurses of higher skill placed in another
area of practice
NURSING Advanced Beginner – demonstrate marginally
EXPERTISE acceptable performance; has enough experience to
grasp aspects of the situation
NURSING
PHILOSOPHIES:
Competent – consistency, predictability and time
management; recognizes patterns and determines
elements of the situation
LEVELS OF
EXPERTISE Proficient – perceives the situation as a whole (big
picture) through analysis

Expert – has an intuitive grasp of the situation

PATRICIA BENNER: STAGES OF NURSING
EXPERTISE NURSING PHILOSOPHIES
METAPARADIGM ASSUMPTION
Environment Situation instead of environment: social environment with social
definition and meaningfulness
Personal interpretation of the situation is bounded by the way the
individual is in it
Person A self-interpreting being defined throughout the course of life
Health What can be assessed vs Well-being is the human experience of
health or wholeness
Illness as a human experience of a loss or dysfunction
Nursing A caring relationship and an enabling condition of connection and
concern
KATIE ERIKSSON

• Finnish-Swedish nurse theorist, educator, and

author
CARITATIVE CARING
THEORY
• Distinguishes caring ethics, the practical
relationship between the patient and the nurse and
nursing ethics
• Nursing ethics as ethical principles that guide a
nurse’s decision-making abilities
• Caritative caring: Love and charity (Caritas) for
human holiness and dignity
• Suffering that occurs as a result of a lack of
caritative care is violation of human dignity.
KATIE ERIKSSON: THEORY OF CARITATIVE
CARING
METAPARADIGM ASSUMPTION
Environment Ethos: the sounding board of all caring; the home or the place where a
human being feels at home; symbolizes a human being’s innermost space
Person A self-interpreting being defined throughout the course of life
Health Pure concept wholeness and holiness
As a movement: determined by needs and desires
As becoming: a movement toward a deeper wholeness and holiness
Nursing Caritas as basic motive of caring, formed by eros and agape
• Eros: egocentric love
• Agapa: Unselfish love
Nursing Care vs Caring Nursing: Process (good) care vs caring without
prejudice that emphasizes the patient and his/her suffering and desires
 1. Roger’s Science of
Unitary Human Beings
2. Orem’s Self Care Deficit

NURSING CARE 3. King’s General Systems

Framework Nursing

MODELS 4.
Conceptual Model
Neuman’s Systems Model
5. Roy’s Adaptation Model
6. Johnson’s Behavioral
System Model
DESCRIBING NURSING MODELS

• Derived from philosophies

• Represents a less complex concept
• Address more specific concepts of person, environment, health, and nursing
• Systematic approach to nursing practice, education, and research
• Guide thinking and decision-making
MARTHA ROGERS
MAY 12, 1914 – MARCH 13, 1994

• American nurse, researcher,

theorist, and author
SCIENCE OF UNITARY
HUMAN BEINGS
Concepts:
1. Energy Field – fundamental unit of both the
living and nonliving; an inevitable part of life.
2. Openness – No boundary or barrier inhibiting the
energy flow between human and environment
3. Pattern – distinguishing characteristic of an
energy field perceived as single waves
4. Pan-dimensionality – nonlinear domain without
spatial or temporal attributes
• Humans have more than three dimensions.
MARTHA ROGERS: SCIENCE OF UNITARY HUMAN
BEINGS
METAPARADIGM ASSUMPTIONS
Environment Entire energy field other than a person
Person Unitary human being which continuously interact with
environment; cannot be viewed as parts but considered
as a whole
Health Determined by interaction between energy fields
Nursing A learned profession, both science and art; exists to
serve people; direct and overriding responsibility to
society
DOROTHEA
OREM
JUNE 15, 1914 -JUNE 22, 2007

• American nursing theorist

• Pioneered the Self Care
Deficit Theory
 • Human beings require continuous, deliberate
SELF CARE inputs to themselves and their environments to
remain alive and function in accordance with
DEFICIT THEORY natural human endowments.
• Human agency is caring for self and others.
• Humans experience privations in the form of
limitations to action in care for self and others.
• Human agency is exercised in discovering,
developing, and transmitting ways and means to
identify needs and make inputs to self and others.
• Groups of human beings with structured
relationships cluster tasks and allocate
responsibilities for providing care to group
members who experience privations for making
required, deliberate input to self and others.
SELF CARE • Theory of Self Care Deficit
• Nursing agency associated with subjectivity of
DEFICIT THEORY: mature and maturing persons to health or

THEORETICAL healthcare-related action limitations

• Theory of Self Care
ASSERTIONS • Self Care must be learned, be performed
deliberately and continuously in time and in
conformity with the regulatory requirements of
the individual
• Theory of Dependent Care
• When providing dependent care, the person is
meeting the self care needs of another.
DOROTHEA OREM: SELF CARE DEFICIT
METAPARADIGM ASSUMPTIONS
Environment Anything that impacts the well-being of a patient
Person Recipient of nurse’s attention, assessment, planning,
intervention, and evaluation, including communities
Health Ability to manage one’s health care needs
• Wholly compensatory state
• Partially compensatory state
• Supportive-educative needs
Nursing Assessing patient’s self-care needs and helping them
overcome limitations
IMOGENE KING
JANUARY 30, 1923 – DECEMBER 24, 2007

• American nurse theorist and

a pioneer of nursing theory
development
GENERAL SYSTEMS FRAMEWORK NURSING
CONCEPTUAL MODEL

Health Nursing Self

• Dynamic life experiences • Process of action, • Composite of thoughts

of a human being → reaction, and interaction and feelings → person’s
continuous adjustment to whereby nurse and client awareness of existence
stressors in the internal share information about • Sum total of all he/she
and external environment their perceptions in the can call his/her own, e.g.
through optimum use of nursing situation ideas, attitudes, values,
one’s resources to achieve and commitments
maximum potential for • A person’s inner world
daily living
IMOGENE KING: GENERAL SYSTEMS
FRAMEWORK NURSING CONCEPTUAL MODEL
METAPARADIGM ASSUMPTIONS
Environment With which an individual continually interacts, which
subsequently influences adjustments to life and health
Person Spiritual beings with ability to record history and
preserve culture and are unique and holistic, of intrinsic
worth, and capable of rational thinking and decision-
making in most situations
Health A dynamic state in the life cycle with illness interfering
that process
Nursing Observable behavior found in the health care of societies
with the goal of helping individuals maintain health
BETTY
NEUMAN

• American nursing theorist

and a pioneer in nursing
involvement in mental health
SYSTEMS MODEL
• Clients are viewed as wholes whose parts
are in dynamic interaction.
• Variables simultaneously affecting the
client system: physiological, psychological,
sociocultural, developmental, and spiritual.
• Stressors have the potential for disrupting
system stability
• Lines of resistance
• Normal Line of Defense
• Flexible Lines of Defense
BETTY NEUMAN: SYSTEMS MODEL

METAPARADIGM ASSUMPTIONS
Environment Internal and external forces surrounding the client,
influencing and being influenced by the client
Person Clients or client systems, e.g. individual, family, group,
community, or social issue
Health A dynamic, constantly changing continuum from
wellness to illness
Nursing Unique profession concerned with whole variables
affecting clients in their environment
SISTER
CALLISTA ROY

• American nun, nurse,

theorist, professor, and
author
ADAPTATION MODEL
Adaptation Internal Processes Adaptive Modes

• The process and 1.Regulator subsystem – 1.Physiological-Physical

outcome whereby person’s physiological Mode
thinking and feeling coping mechanism 2.Self-Concept Group
persons as individuals Identity Mode – body
or in groups use 2.Cognator subsystem – image and self ideals
conscious awareness person’s mental coping 3.Role Function Mode
and choice to create mechanism 4.Interdependence Mode
human and
– through effective
environmental
communication and
integration
relations
SISTER CALLISTA ROY: ADAPTATION MODEL
METAPARADIGM ASSUMPTIONS
Environment Conditions, circumstances, and influences that affect
human development and behavior as an adaptive
system; a stimulus to which a person adapts
• Positive or Negative
• Focal, Contextual, or Residual
Person Holistic beings in constant interaction with environment
and use a system of adaptation to respond to
environmental stimuli
Health State where humans can continually adapt to stimuli
Nursing Facilitation of adaptation
DOROTHY
JOHNSON
AUGUST 21, 1919 – FEBRUARY 4, 1999

• American nurse, researcher,

author, and theorist
BEHAVIORAL SYSTEM MODEL

THERE IS AN ORGANIZATION, A SYSTEM TENDS TO ACHIEVE A BEHAVIORAL SYSTEM → SYSTEM BALANCE =

INTERACTION, BALANCE AMONG THE VARIOUS REGULARITY AND CONSTANCY ADJUSTMENTS AND
INTERDEPENDENCY, AND FORCES OPERATING WITHIN IT IN BEHAVIOR: ESSENTIAL TO ADAPTATIONS THAT ARE
INTEGRATION OF THE PARTS AND UPON IT → MAN TRIES TO MAN SUCCESSFUL
AND ELEMTNS OF THE MAINTAIN A SYSTEM BALANCE
BEHAVIORS THAT GO TO MAKE AND STEADY STATE BY
UP THE SYSTEM. ADJUSTMENTS AND
ADAPTATIONS.
DOROTHY JOHNSON: BEHAVIORAL SYSTEM
MODEL
METAPARADIGM ASSUMPTIONS
Environment Includes all elements of the human system’s
surroundings, including internal stressors
Person Has two major systems: biological (focus of medicine)
and behavioral (focus of nursing)
Health Some degree of regularity and constancy in behavior
and is seen as the opposite of illness
Nursing External regulatory force that acts to preserve the
organization and integrate the patient’s behavior
constitutes a threat to physical or social health or in
which illness is found