“It is the surgeon who saves a person’s lifeit is the nurse who helps a person live” (Florence Nightingale). This famous nursing quote underscores the important role that nurses have played throughout the history of mankind. Florence Nightingale and many other nurses have come up with several nursing theories in a bid to better the profession. Through the evaluation of different theories; learners, practitioners and other interested stakeholders can understand the past and also predict the future of the nursing profession. In this paper, I will focus on two nursing theorists; Florence Nightingale (1820-1910) and University of Colorado’s Distinguished Professor of Nursing, Jean Watson. Florence Nightingale, considered by many as the first nursing theorist is best known for her Environmental Nursing Theory while Jean Watson is best known for her Transpersonal or Human Caring Theory. This paper explains each nursing theory, describes the meta-paradigm concepts relating to persons, environment, health and nursing in the above mentioned theories and also contrasts and critiques differences and similarities between the two theories.
Florence Nightingale’s Environmental Theory set a very good pace for the nursing theorists. In her Environmental Theory, Nightingale asserted that, “nursing is an act of utilizing a patient’s environment to assist that patient to recover” (Selanders, 1998, Pp. 248). As such, Nightingale recommended that nurses should configure environmental settings near a patient in manner that promotes gradual restoration of the patient’s health. Nightingale subdivided the environment into three categories; Physical, psychological and social (Selanders, 1998, Pp. 248). The physical environment relates to the physical elements of the very place where a patient is being treated. According to nightingale nurses should ensure that that environment has pure fresh air, clean and safe water, effective drainage, quietness, ample lighting (especially sunlight) and is basically clean (Fitzpatrick & Whall, 2005). Psychological Health relates to the negative physical environment which causes stress. According to Nightingale, conducive psychological environments are characterized by appealing food, therapeutic communication, pleasing physical environment among other aspects that promote psychological wellbeing (Cook & Cullen, 2003, Pp. 193). The social environment should entail collection of data on illnesses, aspects of the physical environment as well as community (home or hospital room) interactions of persons.
Jean Watson’s theory, developed in 1970 has been severally amended and is currently applied as the post-modern transpersonal caring-healing paradigm. The theory is anchored on the “moral ideal” that contact between two human beings can help the sick person discover new knowledge that will promote harmony and recovery (Foster, 2006, Pp. 332). According to Watson, (1988) in a nurse-patient partnership there are important spiritual, moral and metaphysical components and that human being scan use their spirits to relate to others. Watson (1988) asserts that a human being has three elements; body, mind and soul and that ultimate health is stained when all three are in tandem. Health also encompasses unity of the self (body, mind and soul) with others and the environment. As such, nurses being close to people who need care are inherently compelled to care and promote healing in order to maintain their own health at optimum levels.
There are some key similarities between Nightingale’s and Watson’s theories. While the former explicitly dwells on the subject of the environment, clearly stating how it should be maintained; the latter elaborates on transpersonal care including the care of a patient’s physical environment. According to Tourville, & Ingalls, (2003), Watson primarily urges nurses to regulate the environment and make sure that all factors necessary for healing are present (27). These factors are support, spirituality and protection. Protection entails provision of clean water, air and maintenance of a clean environment to prevent a patient’s condition from deteriorating (Tourville & Ingalls, 2003). As such, Watson perfectly corroborates the assertions of Nightingale’s environmental theory.
Watson model of caring supports the massive paradigm shift in the nursing profession while nightingale’s approach befits the traditional and conservative approach to nursing. However, the social and psychological environments explained in Nightingale’s theory closely relate to the spirituality and support underscored in Watson’s theory. Besides the physical environment, both theorists contend that overall human wellbeing has to do with psycho-social support. They agree that mental health and the absence of stress are crucial yardsticks in ensuring that ultimate health reigns in individuals requiring healthcare.
While Nightingale’s approach to patient psychological support is shallow and generalized, Watson’s approach is elaborate and practical. Watson highlights ten (10) issues related to care “carative factors” in her theory. The six major factors are trust, teaching, altruism, creativity, altruism and spirituality (Cook & Cullen, 2003, Pp. 192). Going by the complexity of healthcare demands in the modern world, Nightingale’s theory and approach to psychological care is wanting. She vaguely mentions that nurses should offer the best possible environment for patients. Watson goes deeper and urges nurses to display unconditional acceptance of patients, treat patients with positive regard, spend interactive moments with patients, and promote awareness among patients among other practical interventions. In fact Watson, states how patients should react when they experience a nurse’s attitude and competence. The patient’s world becomes; threatening or secure, brighter or drab, larger or smaller, rich or dull among other attributes (Watson, 1988, Pp. 37).
There are several differences between Watson’s and Nightingale’s theories. Nightingale’s theory is emphatic on the traditional and conventional medical model of nursing while Watson’s model is anchored on the humanistic values related to nursing where caring is the central focus. In other words, Nightingale dwelt on the core responsibilities of nurses while Watson dwelt on the expanded and holistic responsibilities (Fitzpatrick & Whall, 2005). While nightingale urges nurses to provide appropriate physical environment, she means the provision of clean and safe drinking water, opening windows and ventilations to a room, cleaning the place where a patient is being held among other manual aspects. In contrast, Watson urges nurses to communicate often with their patients, investigate their emotional and psychological past, present and future needs, encourage the patients, counsel them and give all necessary psychological support that the patients may need (Fitzpatrick & Whall, 2005). As such, Watson’s theory dwells more on the non-tangible care roles and responsibilities while Nightingale’s theories dwell more on the tangible care roles and responsibilities.
Watson and Nightingale contributed to the modern paradigm of nursing. In her Environmental Theory, Nightingale emphasized on four meta-paradigm concepts; the person, health, environment and nursing. Jean Watson on the other hand bears the same four concepts. Though worded differently, the core assertions by Watson and Nightingale are almost similar.
In regard to nursing, Nightingale believed and asserted that nursing is different from medicine. The goal of nursing is, “to place the patient in the best possible condition for nature to act” (Fitzpatrick & Whall, 2005). She also added that nursing entails, “activities that promote health occurring in any care-giving situation and that they can be done by anyone” (Tourville, & Ingalls, 2003, Pp. 29). Jean Watson states ‘nursing is concerned with promoting health, preventing illness, caring for the sick and restoring health. As such, the meta-paradigms between these two theories are similar.
In regard to people, Nightingale asserted that people are “multidimensional, composed of psychological, biological, social and spiritual components” (Tourville, & Ingalls, 2003, Pp. 30). Watson adds an interesting dimension when defining a human being. She views a human being as, “a valued person in and of himself who deserves to be cared for, respected, understood, nurtured and assisted.” (Tourville, & Ingalls, 2003, Pp. 30). She adds that a human being is greater than and different from the sum of his or her parts. This last bit gives a more encompassing look at human beings as compared to the definition fronted by Nightingale.
In regard to health, Watson adds three elements that should beaded to the current definition by the World health Organization (WHO). These are; a high level of overall physical, social and mental functioning, general adaptive-maintenance level of daily functioning and thirdly the absence of illness (or the presence of efforts that lead to its absence). Nightingale proffered a simple but captivating look at health. She viewed health as, “not only being well, but also being able to use well every power that one has” (Selanders, 1998, Pp. 249). She considered disease as the absence of comfort.
Watson and Nightingale also offer interesting paradigms on what constitutes health in the context of nursing care. Nightingale states that, “poor or difficult environments lead to poor health and disease”. She also held the view that the environment can be altered to improve conditions so that the natural laws can allow healing to occur (Fitzpatrick & Whall, 2005). Watson on the other hand held the view that a caring attitude is not transmitted from one generation to another. It is transmitted by the culture of the nursing profession as a unique way of coping with its environment.
Florence Nightingale and Jean Watson have offered the nursing profession crucial theories that bear similarities and differences on several fronts. Nightingale’s Environmental Nursing Theory dwells adequately on the physical environment (provision of clean water, air, quietness and a generally clean environment). It also highlights on the psychological and social environments by agitating on the need for nurses to maintain a stress-free environment for their patients. Jean Watson’s Human Caring Theory urges nurses to be present, maintain constant communication with their patients and basically provide a therapeutic environment through proper human interactions. The four meta-paradigm issues; persons, health, environment and nursing are largely similar between Watson and Nightingale. The slight differences between the two come from the depth with which each of them addresses certain aspect. Watson proffers more insight and comprehensive definitions and therefore her theory is more suited for the modern nurses.
Watson, J. (1988). Nursing: human science and human care.. New York: National League for Nursing.
Cook, P. R., Cullen, J. A. (2003). Caring as an imperative for nursing education. Nursing Education Perspectives, 24 (4), 192-197.
Fitzpatrick, J. J., Whall, A. L. (2005). Conceptual models of nursing: analysis and application. Upper Saddle River, New Jersey: Pearson Prentice Hall.
Foster, R. L. (2006). A Perspective On Watson’s Theory Of Human Caring. Nursing Science Quarterly, 19(4), 332-333.
Tourville, C., & Ingalls, K. (2003). The Living Tree Of Nursing Theories. Nursing Forum, 38(3), 21-36.
Selanders, L. C. (1998). The Power Of Environmental Adaptation: Florence Nightingale’s Original Theory For Nursing Practice. Journal of Holistic Nursing, 16(2), 247-263.
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