1.5 Selected Nursing Theorist

Florence Nightingale

Florence Nightingale (1820–1910), known as the founder of modern nursing, was a nurse pioneer and social reformer (Figure 1.5). Named after her birthplace (Florence, Italy), Nightingale is best known for her work during the Crimean War, which led to groundbreaking contributions to nursing and public health. Her unique legacy encompasses not only hands-on nursing but also pioneering work in statistics and epidemiology (Alexander, 2019). Nightingale's legacy is complicated by her participation in colonialist practices, including advising governments on repressing anti-colonial uprisings, and publications in which she expressed belief in the superiority of the British over Indigenous people. Nurses, researchers, and historians debate how the community should incorporate and celebrate Nightingale's contributions to the field (Robinson-Lane & Patel, 2022; D'Antonio, 2022).

Figure 1.5 Florence Nightingale, known as the founder of modern nursing, was a social reformer, statistician, and pioneer for the nursing profession. (credit: “Florence Nightingale,” by JamesGardinerCollection/Flickr, Public Domain)

Nightingale’s prominence rose during the Crimean War, to which she and a team of nurses were called to care for soldiers. Upon arriving at the wards, they were horrified to find unsanitary conditions, such as overcrowded wards, sewage on the floors, and patients covered in filth. Using statistics, Nightingale was able to track the number of deaths; she proved that more soldiers were dying from diseases they picked up in hospitals than from battlefield wounds. She implemented improved sanitation practices and enhanced medical care for wounded soldiers, which significantly reduced mortality rates from 40 to 2 percent (Alexander, 2019). Her statistical analysis of disease was instrumental in establishing the science of epidemiology, which is still used today to track the spread of diseases.

Known for carrying a lamp while she made rounds to check in on soldiers during the night, Nightingale was commonly referred to as “the Lady with the Lamp” by the British soldiers. Her legacy remains strong today; her lamp continues to be an international symbol of nursing and is incorporated into the most important nursing ceremonies. Her 1860 book, Notes on Nursing: What It Is, and What It Is Not, remains a foundational text in nursing education, emphasizing the importance of cleanliness, fresh air, and proper nutrition in patient care (Alexander, 2019).

Also in 1860, Nightingale established the first secular nursing school, at St. Thomas’ Hospital in London. Her pivotal role in formalizing and professionalizing nursing education continues to shape the field today. The Nightingale Pledge, recited by nurses during graduation ceremonies, reflects the ethical commitment she advocated for so strongly. Nightingale’s legacy is also remembered on International Nurses Day, celebrated on May 12 (her birthday), a day that honors her enduring influence on nursing and health care and her dedication to evidence-based practices and patient well-being (Alexander, 2019).

Hildegard Peplau

Hildegard Peplau (1909–1999) was a distinguished nurse, educator, and theorist who made significant contributions to the field of psychiatric nursing (Figure 1.6). Born in Reading, Pennsylvania, Peplau played a crucial role in the development of a theory that revolutionized the approach to nursing care. This theory of interpersonal relations (discussed in Peplau’s Theory of Interpersonal Relations) emphasized the nurse-patient relationship as a therapeutic and collaborative partnership, shifting the focus from a task-oriented model to one centered on understanding and meeting the psychological needs of patients. Peplau’s groundbreaking work laid the foundation for modern psychiatric nursing, stressing the importance of communication, empathy, and mutual respect in facilitating the healing process. Her influential book, Interpersonal Relations in Nursing (1952), remains a seminal text in nursing education. Throughout her career, Peplau held various leadership positions and contributed significantly to the professionalization of nursing. Her enduring legacy extends beyond her theoretical contributions, as she played a pivotal role in shaping the way nurses approach patient care, particularly in mental health settings (Gonzalo, 2023c).

Figure 1.6 Hildegard Peplau was a nursing educator who played a major role in developing the theory and practice of psychiatric and mental health nursing. (credit: “Hildegard-Peplau-1931 Pottstown Hospital Training School Yearbook,” by Pottstown Hospital School of Nursing Yearbook/Wikimedia Commons, Public Domain)

Virginia Henderson

Virginia Henderson (1897–1996) is often referred to as the “First Lady of Nursing.” Born in Kansas City, Missouri, she dedicated her life to nursing and played a crucial role in the development of nursing theory and practice. Henderson’s most notable contribution is her definition 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 peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge” (Henderson & Nite, 1978, p. 5). This definition suggests that nurses help individuals achieve their highest level of independence in activities of daily living. Henderson’s conceptualization of nursing was encapsulated in her nursing need theory (discussed in Henderson’s Nursing Need Theory), which articulates fourteen basic needs that individuals require assistance with during illness. According to Henderson, nurses should focus on meeting these needs to promote health and well-being (Virginia Henderson—Nursing theorist, n.d.).

Throughout her career, Henderson worked in various capacities, including clinical practice, education, and research. She held teaching positions at several prestigious institutions, including Yale University. Henderson also served as a consultant to the United States Public Health Service, the World Health Organization, and the ICN (Virginia Henderson—Nursing theorist, n.d.).

In addition to her theoretical contributions, Henderson authored numerous publications, including the classic Textbook of the Principles and Practice of Nursing (Virginia Henderson—Nursing theorist, n.d.). Her work laid the foundation for modern nursing practice and education, emphasizing the importance of a holistic and person-centered approach. Her legacy continues to shape the field, and her impact is evident in the continued evolution of nursing theory and practice.

Faye Abdellah

Faye Abdellah (1919–2017) was a pioneering researcher and educator who significantly influenced the development of nursing theory and practice (Figure 1.7). Born in New York City, Abdellah developed her theory of patient-centered approaches to nursing (PCAN) in the 1960s. The theory of PCAN focuses on comprehensive patient care, emphasizing the importance of individualized care plans based on patients’ unique needs. Abdellah identified twenty-one nursing problems that could be addressed through nursing interventions, emphasizing a holistic and person-centered approach to health care (Atkins, 2017).

Figure 1.7 Faye Abdellah was a pioneer in nursing research and the first nurse and woman to serve as the deputy surgeon general of the United States. (credit: “abdellah-4” by NIH, Public Domain)

Throughout her career, Abdellah held various leadership positions within the U.S. Public Health Service, as well as teaching positions at Yale University and the Uniformed Services University of the Health Sciences. Abdellah’s commitment to nursing research and education extended beyond her theoretical contributions. She played a key role in advancing nursing research methodology and promoting the integration of research into nursing practice (Atkins, 2017). Her work laid the groundwork for a more systematic and evidence-based approach to nursing care. Abdellah’s impact on nursing is enduring, as her theories and contributions continue to shape nursing education, research, and practice.

Patricia Benner

Patricia Benner is a highly regarded nursing theorist, educator, and author known for her groundbreaking work in the field of nursing education and practice. Born in 1942, Benner has had a profound impact on the way nursing is taught and understood. Benner is perhaps best known for her “novice to expert” model of nursing, which she introduced in 1982. This theory outlines the stages of skill acquisition and development in nursing practice, emphasizing the transition from novice to expert over time. Benner’s model includes five stages: novice, advanced beginner, competent, proficient, and expert. According to her theory, as nurses gain experience, they move through these stages, developing clinical expertise and intuitive understanding of patient care (Dr. Patricia Benner novice to expert—Nursing theorist, n.d.).

Throughout her career, Patricia Benner has held various academic positions. She has also contributed extensively to nursing literature, authoring and coauthoring numerous books and articles that explore topics related to nursing education, clinical practice, and skill development (Dr. Patricia Benner novice to expert—Nursing theorist, n.d.). Benner’s work has had a lasting impact on nursing education and has influenced the way nurses are trained and evaluated in clinical settings. Her emphasis on experiential learning and the importance of practical knowledge in nursing has been instrumental in shaping the profession and promoting the development of competent and expert nurses. Patricia Benner’s contributions continue to be foundational in the field of nursing, influencing both educators and practitioners alike.

Jean Watson

Jean Watson is a distinguished nursing theorist, academic, and author recognized for her significant contributions to the field of nursing. Born in 1940, Watson is renowned for her development of the theory of human caring (discussed in Watson’s Theory of Human Caring), often referred to as the “caring theory.” Introduced in the late 1970s and further expanded in subsequent years, this theory emphasizes the importance of the nurse-patient relationship and views nursing as a holistic and transpersonal experience. According to Watson, caring is at the core of nursing and involves the intentional and genuine connection between the nurse and the patient, incorporating both the physical and spiritual dimensions of care (Watson Caring Institute, n.d.a).

Throughout her career, Jean Watson has held various academic positions and authored numerous books and articles on nursing theory, philosophy, and the importance of caring in health care. Watson’s work has had a profound impact on nursing education, research, and practice, influencing the way nurses approach patient care and highlighting the significance of compassion and human connection in the healing process. Her caring theory continues to be a guiding framework for nurses seeking to provide person-centered and holistic care in diverse healthcare settings.

Dorothea Orem

Dorothea Orem (1914–2007) was a prominent nursing theorist known for her influential work in developing the self-care deficit nursing theory (discussed in Orem’s Self-Care Deficit Nursing Theory). This theory, first proposed in the 1950s and further refined in subsequent decades, revolves around three interrelated concepts: self-care, self-care deficit, and nursing systems. Self-care refers to the activities individuals perform to maintain their health; self-care deficit occurs when individuals cannot meet their own self-care needs. Nursing systems are interventions designed to assist individuals in meeting their self-care needs. According to Orem, individuals have the ability and responsibility to engage in self-care to maintain their health and well-being (Orem’s self-care deficit nursing theory, n.d.).

Throughout her career, Orem held various positions in nursing education and practice. She served as a consultant and held faculty positions at several universities, including Catholic University of America and Case Western Reserve University (Orem’s self-care deficit nursing theory, n.d.). Orem’s theoretical framework has had a significant impact on nursing education, research, and practice, providing a structured approach to understanding and addressing patients’ self-care needs. Her contributions have influenced the development of nursing curricula and the design of patient care plans, emphasizing the importance of empowering individuals to participate in their own care. Orem’s legacy endures as her theory continues to be a foundational component of nursing knowledge and practice.

General Systems Theory

The general systems theory in nursing is a theoretical framework that draws on principles from systems theory to understand and explain the complex and dynamic nature of health care and nursing practice. Developed by biologist Ludwig von Bertalanffy in the mid-twentieth century, the general systems theory posits that any system, including a healthcare system or an individual patient, can be viewed as a complex organization of interacting and interrelated components (Von Bertalanffy, 1972).

In the context of nursing, the general systems theory emphasizes the multifaceted nature of healthcare delivery and the interactions between various components, such as patients, healthcare providers, technology, and organizational structures. This theoretical approach encourages nurses to consider the entire healthcare system rather than focus solely on individual aspects. It underscores how different elements within the healthcare environment are interconnected and how changes in one part of the system can have ripple effects throughout.

The general systems theory has been particularly influential in nursing administration and management, as it provides a framework for understanding how healthcare institutions are organized and how changes in policies, procedures, or personnel can impact the overall functioning of the system. It also emphasizes the importance of holistic and person-centered care by recognizing that patients are dynamic systems influenced by biological, psychological, social, and environmental factors.

Descriptive Theories

A descriptive theory aims to describe phenomena systematically and objectively through the observation and analysis of behaviors and experiences (Wayne, 2023). In psychology, for example, Ivan Pavlov’s work on classical conditioning can be considered descriptive theory, as it systematically describes the process of learning through observing the association of stimuli and responses in animals. Within the field of nursing, these theories focus on providing detailed accounts, categorizations, and classifications of various aspects of nursing, such as patient behaviors, nursing interventions, or healthcare settings. Descriptive theories contribute to the understanding of the complexities within nursing and may serve as a foundation for further research, education, and development of prescriptive theories (Wayne, 2023).

Prescriptive Theories

A prescriptive theory provides guidance on how nursing care should be conducted (Wayne, 2023). These theories go beyond describing phenomena and offer recommendations, interventions, or strategies for achieving specific nursing goals. They are often more action oriented, outlining the steps or principles that should be followed. For example, the theory of experiential learning, developed by David Kolb, prescribes a learning process that involves concrete experiences, reflective observation, abstract conceptualization, and active experimentation. It suggests that individuals learn best when they engage in hands-on experiences, reflect on those experiences, derive abstract principles from their reflections, and then apply these principles in new situations. This prescriptive theory has influenced educational practices that support learning. Within nursing, prescriptive theories guide nursing practice by providing a framework for decision-making and intervention planning (Wayne, 2023).

Adaptation Theories

An adaptation theory focuses on the dynamic process of adaptation that individuals undergo in response to changes in their environment (Wayne, 2023). These theories posit that individuals strive to maintain balance and well-being through adaptive responses to stressors. In ecology, for example, Charles Darwin’s theory of evolution by natural selection is an adaptation theory that explains how species adapt to their environments over time. In nursing, adaptation theories guide the understanding of how patients respond to health challenges and provide a framework for nurses to support and facilitate adaptive processes for optimal patient outcomes.

Developmental Theories

A developmental theory is influenced by broader theories of human development, exploring the stages and transitions individuals go through across their life span (Wayne, 2023). These theories consider physical, cognitive, emotional, and social aspects of development. In nursing, developmental theories are applied to understand the unique needs and challenges faced by individuals at different life stages, guiding nurses in providing age-appropriate and developmentally sensitive care. Erik Erikson’s stages of psychosocial development is an example of a developmental theory that has been applied in nursing to understand the psychological challenges individuals face at different life stages. For instance, applying Erikson’s theory helps nurses recognize and address the unique psychosocial needs of adolescents, adults, and older adults in their care (Wayne, 2023).

Nightingale’s Environmental Theory

Florence Nightingale’s environmental theory, developed during the nineteenth century, is a foundational framework that significantly influenced nursing practice and healthcare environments. Based on her observations and experiences during the Crimean War, the environmental theory posits that the environment plays a critical role in influencing the health and well-being of individuals. Nightingale emphasized the significance of a clean, well-ventilated, and aesthetically pleasing environment in promoting healing and preventing illness. She believed that by modifying the environment, nurses could positively impact patients’ recovery outcomes (Gonzalo, 2023b).

Nightingale’s theory incorporates several key environmental factors, including fresh air, pure water, efficient drainage, cleanliness, and appropriate nutrition. She emphasized the importance of natural light and noise control, recognizing their impact on patient comfort and the overall healing process. Additionally, Nightingale stressed the need for nursing interventions to create a supportive and therapeutic environment, considering factors beyond the physical space, such as social, psychological, and spiritual aspects (Gonzalo, 2023b).

Nightingale’s environmental theory remains relevant today, guiding nurses in the design of healthcare settings that prioritize the creation of environments conducive to healing and recovery. It highlights the interconnectedness of the physical, social, and psychological elements in nursing practice and serves as a reminder of the enduring importance of a health-promoting environment in patient care.

Peplau’s Theory of Interpersonal Relations

Hildegard Peplau’s theory of interpersonal relations, developed in the 1950s, is a landmark framework in nursing that focuses on the interpersonal relationship between the nurse and the patient as a therapeutic process. Peplau emphasized the importance of understanding the dynamics of the nurse-patient relationship in promoting positive health outcomes. The theory consists of four phases: orientation, identification, exploitation, and resolution (Gonzalo, 2023c):

1. In the orientation phase, the nurse and the patient establish a connection, and the patient seeks help.
2. The identification phase involves the patient clarifying their thoughts and feelings, while the nurse assists in defining the problem.
3. During the exploitation phase, the patient utilizes the help offered by the nurse to address the identified problem and gain a better understanding of their situation.
4. Finally, in the resolution phase, the patient resolves the problem and achieves independence with the nurse’s support.

Peplau’s theory views nursing as an interpersonal and therapeutic process, with the nurse acting as a facilitator, resource, and counselor. It underscores the significance of communication, empathy, and mutual understanding in building a therapeutic relationship. Peplau believed this relationship could positively influence the patient’s emotional well-being and contribute to their overall health (Gonzalo, 2023c).

The theory of interpersonal relations has had a lasting impact on nursing practice, guiding nurses in developing meaningful connections with their patients. It has been influential in psychiatric and mental health nursing and has broader applications across various healthcare settings. In the context of mental health care, where trust and empathy are foundational, the theory of interpersonal relations provides a guiding framework for nurses to make connections that extend beyond conventional caregiving. The theory encourages active listening and a deep understanding of patients’ experiences, emotions, and perspectives, proving invaluable to mental health nursing. It fosters collaboration in treatment planning and promotes a nonjudgmental and empathetic attitude, contributing to reducing the stigma associated with mental health conditions. Peplau’s emphasis on the interpersonal aspect of nursing has contributed to the humanization of patient care and remains relevant in contemporary nursing practice.

Leininger’s Culture Care Theory

Madeleine Leininger’s culture care theory, also known as transcultural nursing theory, is a comprehensive framework that emphasizes the importance of cultural competence in nursing care. Developed in the 1950s, Leininger’s theory posits that culture plays a crucial role in shaping an individual’s health beliefs, practices, and responses to illness. The central tenet of this theory is that culturally congruent care, which aligns with the patient’s cultural values, beliefs, and practices, leads to improved health outcomes (Lancellotti, 2008).

Leininger classified nursing care into three modes: cultural care preservation (or maintenance), cultural care accommodation (or negotiation), and cultural care repatterning (or restructuring). Cultural care preservation focuses on maintaining cultural practices that promote health. Cultural care accommodation involves adapting nursing care to align with the patient’s cultural values. Cultural care repatterning aims to assist individuals in changing cultural practices that may be detrimental to their health (Lancellotti, 2008).

The culture care theory emphasizes the need for nurses to be culturally competent and to provide care that respects and incorporates the cultural context of each patient. It recognizes that individuals from diverse cultural backgrounds may have different health beliefs and practices, which must be taken into account to deliver effective and person-centered care. This theory has had a profound impact on nursing education, research, and practice by promoting cultural sensitivity and competence. It encourages healthcare professionals to recognize and respect cultural diversity, fostering a more inclusive and person-centered approach to care. Leininger’s culture care theory remains a foundational framework in transcultural nursing, guiding nurses in delivering culturally congruent and competent care to individuals from various cultural backgrounds.

Orem’s Self-Care Deficit Nursing Theory

Dorothea Orem’s self-care deficit nursing theory is a conceptual framework developed to guide nursing practice by focusing on the individual’s ability to perform self-care activities. Orem introduced this theory in the 1950s and expanded it over subsequent decades. The core premise is that individuals have the capacity for self-care, and nursing interventions are required when individuals are unable to meet their own self-care needs (Orem’s self-care deficit nursing theory, n.d.).

The theory identifies three related components: self-care, self-care deficit, and nursing systems. Self-care encompasses the activities individuals initiate and perform on their own behalf to maintain life, health, and well-being. Self-care deficit occurs when an individual is incapable of meeting their self-care needs adequately. Nursing systems, in this context, refer to actions taken by nurses to assist and support individuals with self-care deficits (Orem’s self-care deficit nursing theory, n.d.).

Orem categorized self-care into two types: universal self-care requisites, which are common to all individuals, and developmentally based self-care requisites, which vary according to an individual’s life stage, health status, and sociocultural factors. The theory proposes that nursing care should be designed to supplement or substitute for an individual’s self-care abilities, aiming to promote independence and prevent or alleviate self-care deficits (Orem’s self-care deficit nursing theory, n.d.).

Orem’s self-care deficit nursing theory has had a profound impact on nursing education, research, and practice. It provides a systematic and comprehensive framework for nurses to assess, plan, and implement interventions that address the self-care needs of individuals. This theory has been instrumental in shaping nursing curricula and guiding the development of person-centered care plans, emphasizing the importance of empowering individuals to participate actively in their own care and promoting optimal health outcomes.

Henderson’s Nursing Need Theory

Virginia Henderson’s nursing need theory is a foundational framework in nursing that delineates the essence and responsibilities of nursing practice. Developed in the 1950s, Henderson’s theory focuses on the role of the nurse in assisting individuals to achieve and maintain health, or to achieve a peaceful death when health is no longer possible (Henderson’s nursing need theory, n.d.).

Central to Henderson’s theory are the fourteen basic needs that individuals require assistance with during times of illness. These needs encompass physiological, psychological, social, and spiritual dimensions (Figure 1.8) (Henderson’s nursing need theory, n.d.).

Figure 1.8 Virginia Henderson’s need theory identifies fourteen basic needs. (attribution: Copyright Rice University, OpenStax, under CC BY 4.0 license)

Nursing need theory has played a crucial role in shaping nursing education and practice, providing a comprehensive framework for understanding and meeting the diverse needs of individuals across the health-illness continuum. Henderson’s emphasis on the holistic nature of nursing care and the promotion of patient independence remains influential in contemporary nursing theories and practices.

Roy’s Adaptation Model

Sister Callista Roy’s adaptation model, developed in the 1970s, is a prominent nursing theory that focuses on the idea of adaptation as the goal of nursing care. This model is based on the belief that individuals are in constant interaction with their environment and that adaptation is a fundamental process for promoting health and well-being (Roy’s adaptation model of nursing, n.d.).

Roy’s theory identifies four key adaptive modes: physiological, self-concept, role function, and interdependence. The physiological mode encompasses the physical processes that contribute to an individual’s health, while the self-concept mode relates to the individual’s perception of themselves. The role function mode involves the roles and responsibilities individuals take on in life, and the interdependence mode focuses on the relationships and connections individuals have with others (Roy’s adaptation model of nursing, n.d.).

The adaptation model proposes that individuals strive for adaptation; when faced with stimuli or stressors, they use adaptive responses to maintain balance and achieve a state of well-being. Nursing, in this context, is viewed as a science and practice that helps individuals adapt to changes in their physiological and psychosocial environment. Nurses assess the adaptive capabilities of individuals and provide interventions to support their adaptation processes.

Roy’s theory has been influential in guiding nursing practice, education, and research. It provides a holistic perspective on the individual as an adaptive system, considering both the biological and psychosocial aspects of health. The adaptation model is particularly applicable in situations where individuals are experiencing changes or challenges, as it emphasizes the importance of nursing interventions that facilitate adaptation and promote optimal health outcomes.

Roger’s Science of Unitary Human Beings Theory

Martha Rogers’s science of unitary human beings theory is a nursing theory that diverges from traditional medical models by focusing on the unitary nature of human beings within the universe. Developed in the 1970s, Rogers’s theory posits that individuals are inseparable from their environment and are characterized by irreducible, indivisible energy fields. In this model, human beings are viewed as open, infinite energy fields that interact with the environment in continuous and evolving patterns (Rogers’s theory of unitary human beings, n.d.).

Rogers’s theory emphasizes the concept of “universe-human-environment process,” considering individuals as integral parts of the broader cosmic environment. The unitary human being is seen as a unified field, not reducible to the sum of its parts, and continuously evolving in patterns of organization and complexity. The science of unitary human beings theory has profound implications for nursing practice, as it underscores the holistic and individualized nature of care. Rogers proposed that nursing interventions should be directed toward patterning and repatterning the energy fields of individuals to promote health and well-being. She advocated for innovative and alternative approaches to health care that recognize the uniqueness of each individual and the dynamic interactions between the person and the environment (Rogers’s theory of unitary human beings, n.d.).

While Rogers’s theory has been considered abstract and challenging to apply in certain healthcare settings, it has contributed significantly to the evolution of nursing thought. It has influenced the development of holistic nursing practices, emphasizing a nonreductionist perspective and encouraging nurses to explore innovative ways of understanding and enhancing the well-being of individuals within the broader context of the universe. Some argue, however, that the lack of robust empirical evidence supporting the theory, complex terminology, and its limited applicability across diverse nursing contexts raises questions about its practical utility. Despite these criticisms, Rogers’s science of unitary human beings theory has sparked important discussions in the nursing community and continues to shape the theoretical landscape of the profession.

Watson’s Theory of Human Caring

Jean Watson’s theory of human caring, introduced in the 1970s and further developed over the years, is a foundational nursing theory that emphasizes the importance of the interpersonal relationship between the nurse and the patient. At the core of Watson’s theory is the belief that caring is central to the discipline of nursing and constitutes the essence of the nurse-patient connection. Watson’s theory incorporates both humanistic and holistic elements, focusing on the spiritual, emotional, and psychological dimensions of care in addition to the physical aspects (Watson Caring Institute, n.d.b). The theory of human caring outlines ten “carative factors” (now called 10 Caritas Processes), which is a framework for caring-healing arts to complement conventional medicine, that serve as a guide for nursing practice (Table 1.3) (Watson Caring Institute, n.d.b).

Watson’s theory encourages nurses to move beyond task-oriented care and connect with patients on a deeper, more meaningful level. It emphasizes the transformative power of caring, not only in promoting physical healing but also in fostering a sense of well-being and dignity. The theory of human caring has influenced nursing education, practice, and research, contributing to the development of person-centered approaches to health care and promoting the idea that caring is an essential and transcendent aspect of the nursing profession.