Early Nursing Theorists

Florence Nightingale.jpg

Florence Nightingale

Florence Nightingale, born into Victorian English society, was an affluent young woman educated in Latin, mathematics, philosophy, religion, and modern languages. She is famous for her role n the Crimean War, on her return to England she decided to use her resources to reform nursing.

She is considered to be the first nursing theorist. One of her theories was the Environmental Theory, which incorporated the restoration of the usual health status of the nurse's clients into the delivery of healthcare—it is still practiced today. In her preface to "Notes on Nursing: what it is and what it is not" she wrote: 

"Every day sanitary knowledge, or the knowledge of nursing, or in other words, of how to put the constitution in such a state as that it will have no disease, or that it can recover from disease, takes a higher place. It is recognized as the knowledge which everyone ought to have -- distinct from medical knowledge, which only a profession can have."[i]

Nightingale stated in her nursing notes that nursing "is an act of utilizing the environment of the patient to assist him in his recovery" (Nightingale 1860/1969),[3] that it involves the nurse's initiative to configure environmental settings appropriate for the gradual restoration of the patient's health, and that external factors associated with the patient's surroundings affect life or biologic and physiologic processes, and his development.

Environmental factors affecting health

  • · Pure fresh air- "to keep the air he breathes as pure as the external air without chilling him/her."

  • · Pure water- "well water of a very impure kind is used for domestic purposes. And when epidemic disease shows itself, persons using such water are almost sure to suffer."

  • · Effective drainage- "all the while the sewer maybe nothing but a laboratory from which epidemic disease and ill health is being installed into the house."

  • · Cleanliness- "the greater part of nursing consists in preserving cleanliness."

  • · Light (especially direct sunlight)- "the usefulness of light in treating disease is very important."

Any deficiency in one or more of these factors could lead to impaired functioning of life processes or diminished health status. The factors posed great significance during Nightingale's time, when health institutions had poor sanitation, and health workers had little education and training and were frequently incompetent and unreliable in attending to the needs of the patients. Also emphasized in her environmental theory is the provision of a quiet or noise-free and warm environment, attending to patient's dietary needs by assessment, documentation of time of food intake, and evaluating its effects on the patient.

Florence Nightingale recognized the necessity for collecting scientific data. Her careful documentation and logical planning during the Crimean War have been credited with reducing the death rate of wounded soldiers from 427 per 1,000 to 22 per 1,000 in a six-month period. Because of her abilities with statistics, she has been called her the "Lady with the Slide Rule”.[ii]

[i] Nightingale, Florence.1860/1969. Notes on Nursing, what it is and what it is not. Preface, p.3 Dover Publications
[ii] Sarkis, op.cit.

Virginia Avenel Henderson

Nurse Theorist, Teacher, Researcher and Author.


Virginia Avenel Henderson was born in Kansas City, Missouri, in 1897. With two of her brothers serving in the armed forces World War I she enrolled in the Army School of Nursing at Walter Reed Army Hospital and graduated in 1921.

As Reverby points out, “the model for the trained nurse stressed discipline, self-sacrifice and order.”[1][i]Regimentation of patient care was common in the hospitals of that time and not unexpected in a military hospital. Students were treated like cadets in the U. S. Military Academy. Courses were taken at Teacher's College, Columbia University under the direction of her mentor, Miss Annie Goodrich.[i] Henderson described her introduction to nursing as a “series of almost unrelated procedures, beginning with an unoccupied bed and progressing to aspiration of body cavities” [ii] (Henderson, 1991,p. 9). Faced with this situation, Virginia Henderson began to question both the Regimentation of patient care and the concept also very prevalent, of nursing as ancillary to medicine. She earned her BS in 1931 and a Master's degree in 1934 from Teachers College, Columbia University,

Nurses practicing in the early twentieth century tended to be task oriented and, while they provided care for patients, few considered nursing’s unique role in health care. Henderson wrote about nursing the way she lived it: focusing on what nurses do, how nurses function, and on nursing’s unique role in health care.[i]

She began her career as a nurse educator in 1924 at the Norfolk Protestant Hospital in Virginia where she was the first and only teacher in the school of nursing. After five years there she returned to New York to begin formal degree studies in nursing at Teacher's College.[i]

Henderson believed that the nurse has the responsibility to assess the needs of the individual patient, help individuals meet their health needs, and/or provide an environment in which the individual can perform activities unaided. In the her 1966 publication, The Nature of Nursing, Henderson stated: “It is my contention that the nurse is, and should be legally, an independent practitioner and able to make independent judgments as long as he, or she, is not diagnosing, prescribing treatment for disease, or making a prognosis, for these are the physician’s functions” (Henderson, 1966, p. 22). [ii]

Henderson’s Concept of Nursing:

“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 a peaceful death) that he would perform unaided if he had the necessary strength, will, or knowledge”.[i]

Read more about Florence Henderson

 Caring Theories

Jean Watson: PhD, RN, AHN-BC, FAAN, (LL -AAN)

Theory of Caring

Jean Watson.jpg

Jean Watson’s theory of human caring focuses on the role of caring in a nurse- patient relationship. Dr. Watson founded and serves as director of the nonprofit Watson Caring Science Institute, dedicated to furthering the work of caring, science, and heart-centered Caritas Nursing, restoring caring and love for nurses’ and health care clinicians’ healing practices for self and others .[i]

Quoting from Jean Watson’s website - Watson Caring Science Institute,

“Caring Science encompasses a humanitarian, human science orientation to human caring processes, phenomena and experiences. Caring Science includes arts and humanities as well as science. A Caring Science perspective is grounded in a relational ontology of being-in-relation, and a world view of unity and connectedness of All….The caring model or theory can also be considered a philosophical and moral/ethical foundation for professional nursing and part of the central focus for nursing at the disciplinary level. A model of caring includes a call for both art and science; it offers a framework that embraces and intersects with art, science, humanities, spirituality, and new dimensions of mindbodyspirit medicine and nursing evolving openly as central to human phenomena of nursing practice. I emphasize that it is possible to read, study, learn about, even teach and Theory Overview in Dr. Watson’s words:

“The Theory of Human Caring was developed between 1975 and 1979 while I was teaching at the University of Colorado. It emerged from my own views of nursing, combined and informed by my doctoral studies in educational, clinical, and social psychology. It was my initial attempt to bring meaning and focus to nursing as an emerging discipline and distinct health profession that had its own unique values, knowledge, and practices, and its own ethic and mission to society.” [i]

The American Journal of Nursing chose Jean Watson’s Caring Science as Sacred Science as book of the Year2004/5 . Caring Science as Sacred Science makes a case for a deep moral–ethical, spirit-filled foundation for caring science and healing that is based on infinite love and an expanding cosmology. This view in turn elicits the finest of nursing as the art, science, and spiritual practice[ii] it is meant to be because it reflects the highest ethical ideal form of compassionate service to society and humanity.

The Core Principles/Practices: Evolving From Carative to Caritas:

  • Practice of loving-kindness and equanimity

  • Authentic presence: enabling deep belief of other (patient, colleague, family, etc.)

  • Cultivation of one’s own spiritual practice toward wholeness of mind/body/spirit—beyond ego

  • “Being” the caring-healing environment

  • Allowing miracles (openness to the unexpected and inexplicable life events)[i]

Watson stresses regarding the caring theory; however, to truly “get it,” one has to personally experience it; thus the model is both an invitation and an opportunity to interact with the ideas, experiment with and grow within the philosophy, and living it out in one’s personal/professional life.”[i]

For complete information about Jean Watson and the Theory of Caring visit her website at https://www.watsoncaringscience.org/jean-bio/caring-science-theory/

[i] Downloaded from Jean Watson’s website - https://www.watsoncaringscience.org/jean-bio/caring-science-theory/

[i] Watson, Jean and Woodward, T.K. 2010 Chapter 20. Jean Watson’s Theory of Caring in Parker, Marilyn & Smith, Marianne, Nursing Theories and Nursing Practice. 3rd. Ed. F.A. Davis, Philadelphia, PA. p. 351

[i] Watson, Jean and Woodward, T.K. op.cit. . p. 352

[i] [i] https://www.watsoncaringscience.org/jean-bio/caring-science-theory/

[i] Downloaded from Jean Watson’s website - https://www.watsoncaringscience.org/jean-bio/caring-science-theory/

[ii] Author’s note : This is not a new concept - my basic nursing program was a hospital based, diploma program in the late 1960’s. The fundamentals of nursing course introduced Alice Price’s concept of the art, science and spirit of nursing.[ii] Price defined nursing as an art which referred to the skilled techniques that nursing must acquire in order to give individual care to patients. Nursing is a science “in that the underlying principles of nursing lie in the knowledge of the biological sciences Nursing is possessed of a spiritual quality in that its primary aim is to serve humanity. As a new nurse I embraced this philosophy as my guide in my practice – caring based on scientific principles which, I believe includes the social sciences. . Source: Price, Alice, 1954. The Art, Science and Spirit of Nursing. W.B. Saunders.

Examples of Watson’s Theory in Practice

UR -Highland Hospital –Rochester NY

Caring ... The Foundation of Highland Nursing

Highland Hospital’s Department of Nursing, our nursing practice is guided by Dr. Jean Watson’s Human Caring Theory evidenced through Patient-Centered Care and Patricia Benner’s Model of Novice to Expert.

Nursing theory is the term given to the body of knowledge that is used to support nursing practice. Nursing models are constructed of theories and concepts. They are used to help nurses assess, plan and implement patient care by providing a framework within which to work. Nursing models also help nurses achieve uniformity and seamless care.

Using Nursing Theory in Our Everyday Care

Nursing theory strengthens our practice by providing structure and a common language. The Human Caring Theory allows us to proclaim our beliefs, values and the very essence of why we became nurses. Our deep roots in caring set Highland nurses apart.

· Caring is based on continuous healing relationships

· Patients are the source and center of care

· Care is customized and reflects values and needs of patients

· Families are an integral part of the care team

· All team members are caregivers

· Caring is provided in an environment of comfort and support

· Transparency is the rule in patient care

· Safety is a visible care priority

· Caregivers focus on the best interest and goals of the patient

For additional information regarding Highland Hospita Nursing Philosophy visit

[1] https://www.urmc.rochester.edu/highland/departments-centers/nursing/nursing-philosophy.aspx