Theoretical Foundations in Nursing - Key Vocabulary

Structure of Nursing Knowledge

• Philosophy:

  • A statement encompassing:
    • Ontological claims about phenomena of central interest.
    • Epistemic claims about how those phenomena come to be known.
    • Ethical claims about what members of a discipline value.

• Conceptual Models:

  • A set of abstract and general concepts addressing phenomena of central interest.
  • Propositions broadly describing these concepts.
  • Propositions stating abstract and general relations between two or more concepts (Fawcett, 2005).

• Theory:

  • A group of related concepts proposing actions that guide practice.

• Concept:

  • Often called the building blocks of theories.
  • Can be abstract or concrete.
  • Mental formulation of an object or event from individual perceptual experience.

• Middle Range Theory:

  • Limited numbers of variables, each of limited scope.
  • Made up of a limited number of concepts and propositions written at a concrete and specific level.
  • Generated or tested by research and used as evidence for practice activities like assessment and intervention.

• Proposition:

  • Idea, proposal, offer, or plan.
  • Supposition: Hypothesis suggested to be true.
  • Assumption: Belief without proof.

• Nursing Theory:

  • Related concepts derived from a nursing model.

• Principle:

  • Basic law, truth, or assumption.

• Conceptual Framework:

  • Conceptual model or grand theories.
    • Id: Unconscious.
    • Ego: Conscious.
    • Superego: Conscience.

• Paradigm:

  • Contains concept theories.

• Metaparadigm:

  • Set of ideas providing structure for how a discipline should function.
  • Consists of central concepts: person, environment, nursing, and health.
  • Concept that can be superimposed on other concepts representing core perspectives of the discipline.

Metaparadigm Concepts

• Person:

  • Recipient of nursing care.
  • Central to the care being provided.
  • May include: individual clients, families, communities.

• Health:

  • The goal of nursing care.

• Environment:

  • Internal and external surroundings affecting the client.

• Nursing:

  • Involves delivery of optimal health outcomes for the patient through a mutual relationship in a safe and caring environment.

History of Nursing Theory Development

• Theory development was an essential part of modern nursing, evidenced by Florence Nightingale's "Notes on Nursing" published in 1859.

• Nurse scholars started developing nursing theories in the 1950s.

• Shift of nursing towards conceptualizing it as a profession based on science rather than apprenticeship.

  • Hospital-based nursing training shifted to college-level educational institutions.

• 1960s: The first doctoral programs in nursing were made available.

• Prior to this, nurses pursued doctorate degrees in related fields (sociology, education, psychology, anthropology) and adapted theories from those fields for use in nursing.

  • This strategy was initially helpful but nursing began to be seen as unique and not fully addressed by theories from other fields.

Eras of Nursing Theory

• Curriculum Era (1920s – 1930s):

  • Emphasis was on curriculum and nursing education.
  • Nursing experienced expansion of nursing programs with an emphasis on nursing principles and procedures and training for basic nursing.

• Research Era (1940s – 1950s):

  • Nursing began to move into higher education.
  • Graduate programs were developed, and nursing research began to be conducted as nursing developed as a scientific discipline.

• Graduate Education Era (1960s – 1970s):

  • Experiment of preparing nurse scientists in other disciplines ended.
  • Direction for the development of the discipline was clarified and led to an immediate expansion of nursing doctorate programs.

• Theory Era (1980s – 1990s):

  • Theory development emphasis began and has now transitioned to reach the theory utilization era and theory-based practice essential for the growth of the nursing profession.

The Future of Nursing Theory

• Meleis (1992) forecasted that nursing theories will become theories for health, developed by nurses, physicians, occupational therapists, and others.

• Predicted that the domain of nursing focusing on environmental-person interactions, energy levels, human responses, and caring would be accepted as a central and complementary perspective in providing health care to clients.

Discipline vs. Profession

• Nursing was not initially recognized as an academic discipline or a profession.

• Recent achievements led nursing to be recognized as both.

• Profession (Udan, 2020):

  • Refers to a specialized field of practice founded on the theoretical structure of the science or knowledge and accompanying practice abilities.

• Discipline:

  • Refers to a branch of education, a department of learning, or a domain of knowledge.

Significance of Nursing Theory

• Gives nurses a sense of identity and helps patients, managers, and other healthcare professionals recognize the unique contribution that nurses make to healthcare service.

• Helps nurses to understand their purpose and role in the healthcare setting.

• Guides knowledge development.

• Directs education, research, and practice.

• Recognizes what should set the foundation of practice by explicitly describing nursing.

• Serves as a rationale or scientific reason for nursing interventions and gives nurses the knowledge base necessary for acting and responding appropriately in nursing care situations.

• Provides the foundations of nursing practice.

• Indicates in which direction nursing should develop in the future.

• Gives nurses a sense of identity.

• Helps patients, managers, and other healthcare professionals acknowledge and understand the unique contribution that nurses make to healthcare service.

• Prepares the nurses to reflect on the assumptions and question the values in nursing, thus further defining nursing and increasing knowledge base.

• Allows the nursing profession to maintain and preserve its professional limits and boundaries.

Significance of Nursing Theory for the Discipline

• Importance of nursing conceptualization in the research process and the role of conceptual framework in research design for production of science.

  • This emphasis led to the theory development era and moved nursing forward to the new nursing knowledge for nursing practice.

• Creative conceptualization of nursing metaparadigm and a structure of knowledge clarified the related nature of the collective works of major nursing theories as conceptual frameworks and paradigms of nursing.

  • This approach organized nursing works into a system of theoretical knowledge, developed by theorists at different times and places.

• Recognition of separate nursing works collectively with a metaparadigm umbrella enhanced the recognition and understanding of nursing theoretical work as a body of nursing knowledge.

• The significance of theory for the discipline of nursing is that the discipline is dependent on theory for its continued existence.

  • Nursing can be a vocation, or nursing can be a discipline with a professional style of theory-based practice.

• Theoretical works have taken nursing levels of education and practice as nurses moved from functional focus with emphasis on what nurses do, to a patient focus, emphasizing what nurses know for thought, decision-making, and action.

• Frameworks and theories are structures about human beings and their health; these structures provide nurses with perspective of the patient for professional practice.

• Professionals provide public service in a practice focused on those whom they serve.

• The nursing process is useful in practice, but the primary focus is the patient, or human being.

• Knowledge of persons, health, and environment forms the basis for recognition of nursing as a discipline, and this knowledge is taught to those who enter the profession.

• Every discipline or field of knowledge includes theoretical knowledge.

  • Therefore, nursing as an academic discipline depends on the existence of nursing knowledge.
  • This knowledge is basic for everyone who will enter into the chosen profession.

• The study of metaparadigms is what mainly prepares the student for membership in a particular scientific community with which he or she will later practice.

• By studying and practicing the metaparadigms the members of the profession learn their trade.

Significance of Nursing Theory for the Profession

• Nursing theory is essential for the existence of nursing as an academic discipline and is vital to the practice of the profession.
• Nursing is recognized today because its development was guided by the criteria for a profession.
• Theories and research are vital to the discipline and profession, so that the new theory-based knowledge continues to be separated.
• Theory informs practice, and practice informs theory. Theory without practice is empty, and practice without theory is blind (Lloyd, 2017).

Components and Purposes of Nursing Theory

*Nursing is an Art, and if it is to be made an art, it requires an exclusive devotion as hard a preparation as any painter’s or sculptor’s work.” - Florence Nightingale

• Purpose:

  • Why is it made?
  • It guides nursing practice and generates knowledge.
  • It helps to describe, predict, or explain a phenomenon.
  • Enables nurses to know “why” they are doing “what” they are doing.

• Concepts:

  • Often called the building blocks of theories.
  • Abstract & concrete; can be discrete or continuous.
  • Mental formulation of an object or event that comes from individual perceptual experience.

• Models:

  • A representation to better understand, explain, or predict something.
  • Represent relationships, flows, structures, or interactions.

• Theoretical Statement:

  • Constitutes connection or relationship of concepts of a theory.
  • Is a statement of how and why specific facts are related.

• Structure:

  • A pattern or the arrangement of and relations between the parts or elements of something complex.

• Assumption:

  • A pattern or the arrangement of and relations between the parts or elements of something complex.

Purpose of Nursing Theory

• Develops analytical skills and critical thinking ability.

• Provides direction and guidance.

• Education:

  • Prepares students for practice as members of the professional community.
  • Helps nursing students understand how roles and actions of nurses fit together in nursing.
  • Theories provide general focus for curriculum design.
  • Theories also guide curricular decision making

• Research:

  • Offers a framework for generating knowledge and new ideas.
  • Assists in discovering knowledge gaps in the specific field of study.
  • Systematic approach to identify questions

• Clinical Practice:

  • Guides critical thinking of nurses.
  • Represents status of nursing as a discipline.
  • Used as a framework for structuring nursing practice.
  • Development of nursing knowledge/ nursing science.

• Assists nurses to describe, explain and predict everyday experiences.

• Serves to guide assessment, intervention, and evaluation of nursing care.

• Provides a rationale for collecting reliable and valid data.

• Helps to establish criteria to measure the quality of nursing care.

• Helps build a common nursing terminology.

• Enhances autonomy of nursing.

Categories of Nursing Theory

• Philosophies
• Conceptual Model and Grand Theories
• Nursing Theories
• Middle Range Nursing Theories

Four Ways of Knowing

• Empirical – Factual
• Ethical – Moral obligations / right or wrong
• Aesthetic – Artful performance
• Personal – Nurse / patient relationship

Nursing Processes

• Assessment
• Diagnosis
• Planning
• Intervention
• Evaluation

Florence Nightingale | Environmental Theory

• About the Theorist:

  • Born in May 12, 1820, in Florence, Italy.
  • At 24, she decided to help the suffering masses and desired to work in a hospital.
  • Served the wounded soldiers during the Crimean War.

• Worked intensely during her lifetime to effect all types of reforms in nursing.

  • Given the title “Founder of Modern Nursing” for her works in reforming the nursing discipline.

• Established a school of nursing at St. Thomas Hospital in England.

• Wrote many manuscripts about hospital reform and nursing care (Udan, 2020).

• Expressed the vision that nursing was a vocation and a noble undertaking that required discipline and training.

• In 1859, Nightingale wrote "Notes on Nursing: What it is and What it is Not."

  • Expressed the belief that all women would be called upon to “nurse” family or friends.
  • The act of nursing required educated and meticulous planning by those wishing to provide effective nursing care (Nightingale, 1859).

• Lady with the Lamp.

• Mother of Modern Nursing.

Canons of the Environmental Theory

• Health of Houses:

  • Closely related to the presence of pure air, pure water, efficient drainage, cleanliness, and light.
  • ‘Badly constructed houses do for the healthy what badly constructed hospitals do for the sick. Once air is stagnant, sickness is certain to follow’ (Nightingale, 1859).
  • Cleanliness outside the house affected the inside.

• Ventilation and Warmth:

  • Essential to “keep the air he breathes as pure as the external air, without chilling him.”
  • Believed a person who repeatedly breathed their own air would be sick or remain sick.
  • Noxious air or foul odors affect the client’s health.
  • Importance of room temperature (not too warm or too cold).

• Light:

  • The sick needs both fresh air and light—direct sunlight was what clients wanted.
  • Light has ‘quite real and tangible effects upon the human body.”
  • Sick rarely lie with their face toward the wall but are much more likely to face the windows, the source of the sun.

• Noise:

  • Patients should never be waked intentionally or accidentally during the first part of sleep.
  • Noise should always be kept at a minimum around patients at all times.

• Variety:

  • Critical aspect affecting the patient’s recovery.
  • Need for changes in color and form, including bringing the patient brightly colored flowers or plants.
  • Advocated reading, needlework, writing, and cleaning as activities to relieve the sick of boredom.

• Bed and Beddings:

  • Adult exhales about three pints of moisture through the lungs and skin in a 24-hour period. This organic matter enters the sheets unless bedding is changed and aired frequently.
  • The bed should be placed in the brightest part of the room and placed so that the patient could see out of the window.
  • Important for nurses to keep bedding clean, neat, and dry and to position the patient for maximum comfort.

• Cleanliness:

  • The greater part of nursing consists in preserving cleanliness.
  • Floors should be easily cleaned rather than covered with carpets; dust removed with damp cloth.
  • Furniture and walls should be easily washed and not damaged by coming in contact with moisture.

• Personal Cleanliness:

  • Function of the skin is important.
  • Unwashed skin may contaminate or poison the patient; bathing and drying the skin provided great relief to the patient.
  • Personal cleanliness extended to the nurse, and every nurse ought to wash her hands very frequently during the day.

• Nutrition and Taking Food:

  • Importance of variety in the food served to patients.
  • Attention given to the patient affected how the patient ate.
  • Individuals desire different foods at different times of the day, and more frequent small servings may be more beneficial.
  • No business should be done with patients while they are eating because this was distraction.

• Chattering Hopes and Advices:

  • Stressful for a patient to hear opinions after only brief observations had been made; false hopes are depressing to patients.
  • Encouraged the nurse to heed what is being said by visitors, believing that sick persons should hear good news that would assist them in becoming healthier.

• Observation of the Sick:

  • The most important practical lesson that can be given to nurses is to teach them what to observe, how to observe, what symptoms indicate improvement, which are evidence of neglect, and what kind of neglect. (Nightingale, 1859)
  • Importance of obtaining complete and accurate information about patients.
  • Urges precise, specific, and individualized questions and observations and warns against failure to observe and the use of averages to describe expectations of the individual.
  • Observation should not be an end unto itself but a means for assuring that appropriate actions are taken.

• Petty Management:

  • “Petty management” or ways to assure that “what you do when you are there, shall be done when you are not there” ensures continuity of care.
  • The house and the hospital needed to be well-managed, which means being organized, clean, and with appropriate supplies.

Metaparadigm (Nightingale)

• Person:

  • Referred to the person as a patient.
  • Nurses performed tasks to and for the patient and controlled the patient’s environment to enhance recovery.
  • Nightingale described a passive patient although there are specific references made to the patient performing self-care when possible and being involved in the timing and substance of meals.
  • Nurse ask the patient about his or her preferences because Nightingale saw each patient as an individual.
  • Emphasized that the nurse was in control of and responsible for the patient’s environmental surroundings.
  • Nightingale had respect for persons of various backgrounds and was not judgmental about social worth.

• Nursing:

  • Every woman, at one time in her life, would be a nurse in the sense that nursing is being responsible for someone else’s health.
  • Nightingale’s book Notes on Nursing was published originally in 1859 to provide women with guidelines for caring for their loved ones at home and to give advice on how to “think like a nurse” (Nightingale, 1969, p. 4).
  • Trained nurses would learn additional scientific principles to be applied in their work and were to be more skilled in observing and reporting patients’ health status while providing care as the patient recovered.

• Health:

  • Defined health as being well and using every power (resource) to the fullest extent in living life.
  • Saw disease and illness as a reparative process that nature instituted when a person did not attend to health concerns.
  • Envisioned the maintenance of health through prevention of disease via environmental control and social responsibility.

• Environment:

  • Nursing was “to assist nature in healing the patient."
  • Assumptions and understanding about the environmental conditions of the day were most relevant to her philosophy.
  • Believed that sick poor people would benefit from environmental improvements that would affect both their bodies and their minds.
  • Nurses could be instrumental in changing the social status of the poor by improving their physical living conditions.

Nursing Purpose Clinical Practice (Nightingale)

• Nightingale’s nursing principles remain the foundation of nursing practice.

• The environmental aspects of her philosophy remain integral component of nursing care.

• As nurses practice in this 21st century, the relevance of these concepts continues and have increased relevance as a global society faces new issues of disease control.

• Education:

  • Nightingale’s principle of nurse training provided a universal template for early nurse training schools, beginning with St. Thomas Hospital and King’s College Hospital in London.
  • Nightingale understood that good practice could result only from good education.

• Research:

  • Nightingale’s interest in scientific inquiry and statistics continue to define the scientific inquiry used in nursing research.
  • She was exceptionally efficient and resourceful in her ability to gather and analyze data; her ability to represent data graphically was first identified in the polar diagrams, the graphical illustration that she invented.
  • When Nightingale’s writings are defined and analyzed as theory, they present a philosophical approach that is applicable in modern nursing today.

Patricia Benner | Stages of Nursing Expertise

• About the Theorist:

  • Born in Hampton, Virginia on January 01, 1942, but grew up in California.
  • 1964 - Obtained degree in Bachelor of Arts in Nursing from Pasadena College.
  • 1970 - Earned Master’s Degree in Nursing with major emphasis in Medical-Surgical Nursing from University of California, San Francisco (UCSF) School of Nursing.

• Wide range of clinical experience: Acute Medical Surgical, Critical Care, and Home Health Care.

  • 1982 - PHD in Stress, Coping, and Health bestowed at University of California, Berkley.
  • 2011 – Honored as a “Living Legend” by the American Academy of Nursing.

Major Concepts and Definitions

• Aspects of a Situation:

  • Recurring situational components because the performer/nurse has previous experiences.

• Attributes if a Situation:

  • Measurable properties of a situation without previous experience.

• Competency:

  • “An interpretively defined area of skilled performance identified and described by its intent, functions, and meanings” (Benner, 1984a, p.292)

• Domain:

  • Area of practice with the same competencies and interests.

• Exemplar:

  • First-person-experience-near narrative of a clinical situation

• Experience:

  • Is an active process of refining and changing preconceived theories, notions, and ideas during actual situations.

• Maxim:

  • Apt phrase that points out how to perform in a situation. Instructions that are made requiring a certain level of experience.

• Paradigm Case:

  • A clinical experience that stands out and alters the way the nurse will perceive and understand future clinical situations. It creates and opens new clinical understanding, perspectives, and alternatives.

• Salience:

  • Perceptual stance or embodied knowledge where the aspect of a situation stands out as more or less important.

Brief Description of the Theory

• Benner's Novice to Expert theory asserts that expert nurses develop their knowledge of patient care and extensive skill set by obtaining experiences collected over a course of time as well as having an education background.

• Focuses on how nurses acquire their nursing knowledge, particularly how a nurse could gain knowledge or "know-how" without learning a theory, referred to as "know-that."

• The five levels represent an overall change in two aspects of a nurse's skills, increased independence in reliance on abstract ideas and principles and an increase in critical thinking.

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."

• 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.

Stages of Nursing Expertise

• Novice:

  • No experience, taught with general rules to perform the said task.
  • Ex. “Tell me what I need to do and I’ll do it.”

• Advanced Beginner:

  • Displays respectable performance and has past experience in real-world nursing circumstances. It aids nurses in identifying significant or repetitive elements, in which they can apply their based experiences.
  • Principles, based on experiences, begin to be formulated to guide actions

• Competent:

  • These nurses are more organized and efficient because they are more conscious of long-term objectives and get perspective through organizing their own efforts.
  • Typically, a nurse with 2-3 year’s experience on the job in the same area or in similar day-to-day situations

• Proficient:

  • Stage where the nurse perceives and understands the situation in whole parts. The nurse also has good grapes in certain or preceding situations that are about to happen
  • More holistic understanding improves decision-making

• Expert:

  • The stage where the performer no longer relies on analytical principle. Benner describes the performer as having a much more intuitive grasp, without losing much valuable time
  • No longer relies on principles, rules, or guidelines to connect situations and determine actions

Metaparadigm (Benner)

• Person:
  • “A person is a self-interpreting being, that is, the person does not come into the world predefined but gets defined in the course of living life. A person also has an effortless and non reflective understanding of the self in the world” (p. 41)

4 Major Aspect of Understanding That a Person Must Deal With:
* Role of Situation
* Role of the Embodied Intelligent Agent
* The Role of Personal Concerns
* The Role of Temporality

• Embodiment:

  • The capacity of the body to respond to meaningful situations. They point out that nurses seek to understand the role of embodiment in particular situations of health, illness, and recovery (Benner, 1989)

• Nursing:

  • Nursing is described as a caring relationship, an “enabling condition of connection and concern” (Benner, 1989, p. 4).
  • “Caring is primary because caring sets up the possibility of giving help and receiving help” (Benner, 1989, p. 4
  • Nursing is viewed as caring practice whose science is guided by the moral art and ethics of care and responsibility” (Benner, 1898, p.XI)

• Health:

  • Define as what is assessed, whereas well-being is the human experience of health or wholeness. Well-being and being ill are understood as distinct ways of being in the world

• Situation/Environment:

  • Situation - Conveys a social environment with social definition and meaningfulness.
  • Being Situated and Situated Meaning - Defined by the person’s engaged interaction, interpretation, and understanding of the situation
  • “Personal interpretation of the situation is bounded by the way the individual is in it” (Benner, 1989,p.84)

Purpose of Nursing Theory (Benner)

• Education:

  • Benner endorses more recent efforts to incorporate broader, integrative, context dependent competencies into professional education.
  • The study “Where is the nurse in nurse practitioner?” from Brykczynski produced an adaptation of Benner's original domains and competencies for nurse practitioners (NPs)
  • In Clinical Wisdom and Interventions in Critical Care, Benner and colleagues (1999) urged greater attention to experiential learning and presented the work as a guide to teaching
  • The second edition of Clinical Wisdom and Interventions in Critical Care (Benner et al., 2011) includes a chapter on the educational implications and recommended teaching strategies from the national study of nursing education educating nurses: a call for radical transformation (Benner et, al., 2010)

• Clinical Practice:

  • Dolan - Usefulness for preceptor development, orientation programs, and career development
  • Huntsman and colleagues - Implementation of a clinical ladder to recognize and retain experienced nurses
  • Ullery - Usefulness for conducting annual excellence symposia to develop clinical knowledge
  • Fenton - An ethnographic study of the performance of clinical nurse-specialists (CNSS)

*Silver (1986) and Balasco and Black (1988) - Differentiating clinical knowledge development and career progression in nursing 1990
* Neverveld - Development of basic and advanced preceptor workshops
* Farrell and Bramadat - Better understanding of the development of clinical reasoning skills in actual practice situations
* Crissman and Jelsma - Develop cross-training program to address staffing imbalances

• Research:
  • 1983 - Introduction of interpretive phenomenology as a qualitative research
  • 1994 - Edited and contributed to interpretive phenomenology: embodiment, caring, and ethics in health and illness.
  • 2010 - Large-scale collaborative study with trI service military nursing research group

Jean Watson | Theory of Transpersonal Caring

• About the Theorist:

  • Grew up in West Virginia in the Appalachian Mountains
  • Youngest of eight
  • Attended Lewis Gale School of Nursing in Roanoke, Virginia.
  • Continued her nursing education and graduate studies in Unicersity of Colorado.
    • Master’s Degree in Psychiatric-Mental Health Nursing
    • Doctorate in Educational Psychology & Counselling

• 1st - Nursing: The Philosophy and Science of Caring (1979).

• 2nd - Nursing: Human Science and Human Care- A Theory of Nursing

• 3rd - Postmodern Nursing and Beyond was presented as a model to bring nursing practice into the twenty-first Century

Transpersonal Caring

• Fundamental theme:

  • How nurses treat their patients and how this treatment develops into better strategies
  • Transform technical-medical techniques to caring-healing transpersonal awareness

• Transpersonal Awareness:

  • "Union with the other person and in a special kind of human care relationship. "

• Goal:

  • Transform technical-medical techniques to caring-healing transpersonal awareness

• 10 Carative Factors

  1. Formation of a humanistic altruistic system of values
  2. Instillation of faith-hope
  3. Cultivation of sensitivity to self and others
  4. Cultivation of sensitivity to self and others
  5. Promotion and acceptance of the expression of positive and negative feelings
  6. Systematic use of the scientific problem-solving method for decision making
  7. Promotion of interpersonal teaching learning
  8. Provision for a supportive, protective, and corrective mental,
     physical, sociocultural, and spiritual environment
  9. Assistance with gratification of human needs
  10. Allowance for existential phenomenological forces

• 10 Caritas Process

  1. “Practice of loving-kindness and equanimity within the context of caring consciousness”
  2. “Practice of loving-kindness and equanimity within the context of caring consciousness”
  3. “Cultivation of one’s own spiritual practices and transpersonal self-going beyond the ego self”
  4. “Developing and sustaining a helping trusting authentic caring relationship”
  5. “Developing and sustaining a helping trusting authentic caring relationship”
  6. “Creative use of self and all ways of knowing as part of the caring process; to engage in the artistry of caring-healing practices”
  7. “Engaging in genuine teaching-learning experience that attends to unity of being and meaning, attempting to stay within others’ frame of reference”
  8. “Creating healing environment at all levels (physical as well as nonphysical, subtle environment of energy and consciousness, whereby wholeness, beauty, comfort, dignity, and peace are potentiated)”
  9. “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”
  10. “Opening and attending to spiritual-mysterious and existential dimensions of one’s own life-death; soul care for self and the one being-cared for”

Major Assumptions

• Watson describes assumptions for a transpersonal caring relationship extending to multidisciplinary practitioners:

  1. Moral commitment, intentionality, and Caritas consciousness by the nurse protect, enhance, and potentiate human dignity, wholeness, and healing, thereby allowing a person to create or co-create his or her own meaning for existence.

  2. The conscious will of the nurse affirms the subjective and spiritual significance of the patient while seeking to sustain caring in the midst of threat and despair—biological, institutional, or otherwise. The result is honoring of an I-Thou relationship rather than an I-It relationship.

  3. The nurse seeks to recognize, accurately detect, and connect with the inner condition of spirit of another through genuine presence and by being centered in the caring moment; actions, words, behaviors, cognition, body language, feelings, intuition, thoughts, senses, the energy field, and so forth, all contribute to the transpersonal caring connection.

  4. The nurse’s ability to connect with another at this transpersonal spirit-to-spirit level is translated via movements, gestures, facial expressions, procedures, information, touch, sound, verbal expressions, and other scientific, technical, Aesthetic, and human means of communication, into nursing human art/ acts or intentional caring-healing modalities.

  5. The caring-healing modalities within the context of transpersonal caring/Caritas consciousness potentiate harmony, wholeness, and unity of being by releasing some of the disharmony, that is, the blocked energy that interferes with natural healing processes; thus the nurse helps another through this process to access the healer within, in the fullest sense of Nightingale’s view of nursing.

  6. Ongoing personal and professional development and spiritual growth, as well as personal spiritual practice, assist the nurse in entering into this deeper level of professional healing practice, allowing for awakening to a transpersonal condition of the world and fuller actualization of the “ontological competencies” necessary at this level of advanced practice of nursing.

  7. The nurse’s own life history, previous experiences, opportunities for focused study, having lived through or experienced various human conditions