Nursing Theory alligood 8th edition

182 UNIT II  Nursing Philosophies people’s conception of health (1998; Lindholm &
caring administration, and interdisciplinary research. Eriksson, 1998) and Bondas’ study of women’s health
Eriksson’s caritative caring theory has been tested and during the perinatal period (2000; Bondas & Eriksson,
further developed in various contexts with different 2001) led to doctoral dissertations.
methodological approaches, both within the depart-
ment’s own research projects and in doctoral disserta- The ontological health model subsequently formed
tions that have been published at the department. the basis for several studies. Wärnå (2002), in her study
concerning the worker’s health, related Aristotle’s the-
Eriksson has always emphasized the importance ory of virtue to Eriksson’s ontological health model.
of basic research as necessary for clinical research, The study opened a new line of thought in preventive
and her main thesis is that substance should direct health service in working environments; continued
the choice of research method. In her book, Pausen research and development are now in progress in a
(The Pause) (Eriksson, 1987b), she describes how the number of factories in the wood-processing industry
research object is structured, starting from the carita- in Finland.
tive theory of caring. In her book, Broar (Bridges)
(Eriksson, 1991), she describes the research paradigm Since the mid-1980s, when suffering as the basic
and various methodological approaches based on a category in caring was made explicit in Eriksson’s
human science perspective. During the first few years, theory, examples of research related to suffering have
the emphasis lay on basic research, with the focus on been legion. One is Wiklund’s (2000) study of suffer-
development of the basic concepts and assumptions ing as struggle and drama, among both patients
of the theory and on the fundamentals of history and who had undergone coronary bypass surgery and
the history of ideas. An especially strong point in patients addicted to drugs. In several clinical studies,
Eriksson’s research is the clearly formulated theoreti- Råholm focused on suffering and alleviation of suffer-
cal perspective that confers explicitness and greater ing in patients undergoing coronary bypass surgery
depth to the generation of knowledge. Development (Råholm, Lindholm, & Eriksson, 2002; Råholm, 2003).
of the theory and research have always moved hand in The manifestation of suffering in a psychiatric context
hand with the focus on various dimensions of the has been studied by Fredriksson, who illustrates the
theory, and, in this connection, we wish to illustrate possibilities of the caring conversation in the allevia-
some central results of the research. tion of suffering (Fredriksson, 2003; Fredriksson
& Eriksson, 2003; Fredriksson & Lindström, 2002).
Eriksson has emphasized the necessity of an exhaus- Nyback (2008) studied suffering in the Chinese cul-
tive and systematic analysis of basic concepts, and ture, and Lindholm (2008) focused on suffering and
developed her own model of concept development its connection to domestic violence. In a Norwegian
(Eriksson, 1991, 1997b), which proved fruitful and is study, Nilsson (2004) studied suffering in patients in
used by many researchers, including Nåden (1998) in psychiatric noninstitutional care units with a high
his study of the art of caring, von Post (1999) in her degree of ill health and found that the experience of
study of the concept of natural care, Sivonen (2000) in loneliness is of basic importance. Caspari (2004) in her
studies of the concepts of soul and spirit, and Kasén study illustrated the importance of aesthetics for
(2002) in her study of the concept of the caring relation- health and suffering.
ship. Other studies focused on the concept of dignity
(Edlund, 2002), the concepts of power and authority In a cooperative project between researchers in
(Rundqvist, 2004), and the concept of the body in a Sweden and Finland, the suffering of women with
perioperative context (Lindwall, 2004). breast cancer was studied. This project comprised in-
tervention studies in which the importance of different
Continued development of Eriksson’s concept of forms of care for the alleviation of suffering was illus-
health took place in the research project Den Mång- trated (Arman, Rehnsfeldt, Lindholm, & Hamrin,
dimensionella Hälsan (Multidimensional Health), 2002; Arman-Rehnsfeldt & Rehnsfeldt, 2003; Lindholm,
during the years 1987 to 1992 and resulted in the on- Nieminen, Mäkelä, & Rantanen-Siljamäki, 2004).
tological health model (Eriksson, 1994a; Eriksson, Arman-Rehnsfeldt, in her dissertation, illustrated how
Bondas-Salonen, Fagerström, et al., 1990; Eriksson & the drama of suffering is formed among these women
Herberts, 1992). The project resulted in a number of (Arman, 2003).
master’s theses. Of these, Lindholm’s study of young

Continuous research has been carried out since the CHAPTER 11  Katie Eriksson 183
1970s, with a view toward developing caring science as
an academic discipline, and a theory of science for car- different depending on what object of knowledge con-
ing science has been formulated (Eriksson, 1988, 2001; stitutes the focus of research (Eriksson & Lindström,
Eriksson & Lindström, 2000, 2003; Lindström, 1992). 2003). Another central area of interest for Eriksson
Eriksson has developed subdisciplines of caring science, (2003) is formed by the development of caritative car-
which means that researchers of caring science and ing ethics. Continued development of the caritative
other scientific disciplines enter into dialogues with theory of caring also occurs, as has emerged before,
each other, and constitute a research area. An example through continued implementation and testing in
of this is the development of caritative caring ethics various clinical contexts.
(Andersson, 1994; Eriksson, 1991, 1995; Fredriksson &
Eriksson, 2001; Råholm & Lindholm, 1999; Råholm, Critique
Lindholm, & Eriksson, 2002). Another interesting sub- Clarity
discipline that Eriksson has developed is caring theol-
ogy, within which she has articulated spiritual and The strong point of Eriksson’s theory is the overall
doctrinal questions in caring with a scientific group of logical structure of the theory, in which every new
themes, and in this respect has cleared the way for new concept becomes a part of an ever more comprehensive
thinking. Caring theology has aroused great interest whole in which an element of internal logic can be seen
among caregivers in clinical practice that can be studied clearly. Her main thesis has always been that basic con-
in academic courses. ceptual clarity is needed before developing the contex-
tual features of the theory. Eriksson has used concept
Further Development analysis and analysis of ideas as central methods, which
has led to semantic and structural clarity. It has at the
Eriksson continues developing her thinking and the same time meant that the concepts may have assumed
caritative caring theory with unabated energy and dimensions that have been regarded as strange to those
constantly finds new ways, recreating and deepening who are not familiar with the theoretical perspective in
what has been stated before. Systematic research and which the development of the theory has taken place.
the development of caritative caring theory, as well as We, who have for many years had the opportunity to
the discipline of caring science, take place chiefly follow Eriksson’s work, have realized that her way of
within the scope of the research programs in her own thinking forms a logical whole, where the abstract sci-
department with her own staff and the postdoctoral entific reveals the concrete in a new understanding
group. The dissertation topics of doctoral candidates (i.e., provides an experience of evidence and verifies
are connected with the research programs and form the convincing force of the theory).
an important contribution of knowledge to the ongo- Simplicity
ing development of Eriksson’s thinking. The theoretical clarity of Eriksson’s theory reflects the
simplicity of the theory by showing the general in a
During the last few years, Eriksson has emphasized clear and logical conceptual entirety. The hermeneutic
the necessity of basic research in clinical caring sci- approach has deepened the understanding of the sub-
ence, where she has especially stressed the under- stance and thus contributed to the simplicity of the
standing of the research object, caring reality. She theory (Gadamer, 1960/1994). The simplicity also can
describes the object of research from three points of be understood as an expression of Gadamer’s concept
view: the experienced world, praxis as activity, and the of theory by making it comprehensible that theory and
real reality. In the real reality, which carries the attri- practice belong together and reflect two sides of the
butes of mystery, one finds something of the deepest same reality. Eriksson agrees with Gadamer’s thought
potential of caring, and it is a reality that can be under- that understanding includes application, and the the-
stood in Gadamer’s sense, in the old Greek meaning ory opens the way to deeper participation and com-
of praxis, as a way of living, a mode of being, that is, munion. Eriksson (2003) formulates this process by
an ontology (Gadamer, 2000). The development of the statement that “ideals reach reality and reality
knowledge in caring science becomes fundamentally reaches the ideals” (p. 26).

184 UNIT II  Nursing Philosophies level developing concepts and theory, the theory is
rooted in clinical reality and teaching. The whole cari-
Generality tative theory and the caring that are built up around
Eriksson’s theory is general in the sense that it aims at the theoretical core get their distinctive character
creating an ontological and ethical basis of caring, and deeper meaning. The ultimate goal of caring is to
while at the same time it constitutes the core of the alleviate suffering and serve life and health.
discipline and thus involves epistemology as well.
Eriksson’s theory is also general as a result of the wide Knowledge formation, which Eriksson sees as a her-
convincing force it receives through its theoretical meneutic spiral, starts from the thought that ethics pre-
core concepts and its theoretical axioms and theses. cedes ontology. In a concrete sense, this implies that the
There may be a risk that a too-general theory be- thought of human holiness and dignity is always kept
comes diffuse in relation to different caring contexts. alive in all phases of the search for knowledge. Ethics
Eriksson, however, has always stressed the impor- precedes ontology in theory as well as in practice.
tance of describing the core concepts on an optimal
level of abstraction in order to include all of the com- Eriksson’s caring science tradition and discipline
plex caring reality that simultaneously carries a wealth of caring science form a basis for the activity at the
of signification that opens up understanding in vari- Department of Caring Science at Åbo Akademi Univer-
ous caring contexts. sity. Eriksson’s caritative caring theory and the discipline
Accessibility of caring science have inspired many in the Nordic
Eriksson’s thinking as a whole has reached an under- countries, and they are used as the basis for research,
standing that extends to other disciplines and profes- education, and clinical practice. Many of her original
sions. She has developed a language and a rhetoric textbooks, published mainly in Swedish, have been
that has reached researchers as well as practitioners in translated into Finnish, Norwegian, and Danish.
the human scientific field. The empirical precision of
Eriksson’s theory demonstrated in multiple deductive CASE STUDY
testings manifests a combination of the clarity, sim- The case presented is a philosophy of practice, by Ulf
plicity, and generality of the theory combined with a Donner, leader of the Foundation Home at the psy-
rich substance and clearly formulated ethos. chiatric nursing home in Finland that for 15 years
Importance has based its practice on Eriksson’s caritative theory
Eriksson’s work on developing her caritative caring of caring.
theory for 30 years has been successful, and particularly
in the Nordic countries there is abundant evidence that Even at an early stage in our serving in caring
her thinking is of great importance to clinical practice, science, we caregivers recognized ourselves in the
research, and education, and also to the development of caring science theory, which stresses the healing
the caring discipline. By her development of the carita- force of love and compassion in the form of tend-
tive theory of care, Eriksson created her own caring ing, playing, and learning in faith, hope, and char-
science tradition, a tradition that has grown strong and ity. The caritative culture is made visible with
has set the tone for nursing advancement and caring the help of rituals, symbols, and traditions, for
science. instance, with the stone that burns with the light
of the Trinity and the daily common time for
Summary spiritual reflection. In every meeting with the suf-
fering human being, the attributes of love and
Eriksson has been a guide and visionary who has gone charity are striven for, and the day involves discus-
before and “ploughed new furrows” in theory develop- sions of reconciliation, forgiveness, and how we as
ment for many years. Eriksson’s caritas-based theory caregivers can tend by nourishing and cleansing
and her whole caring science thinking have developed on the level of becoming, being, and doing. In the
over the course of 30 years. Characteristic of her struggle in love and compassion to reach a fellow
thinking is that while she is working at an abstract human being who, because of suffering, has with-
drawn from the communion to find common

horizons, the sacrifice of the caregiver is con- CHAPTER 11  Katie Eriksson 185
stantly available. we often recognize the importance of teaching the
patient to be able to mourn disappointments and
We work with people who often have the feeling affirm the possibilities of forgiveness in the move-
that they do not deserve the love they encounter ment of reconciliation.
and who, in various ways, try to convince us care-
givers of this. We experience patients’ disappoint- We also try to bring about the open invitation to
ment in their destructive acts, and we constantly the suffering human being to join a communion
have to remember that it may be broken promises with the help of myths, legends, and tales con-
that produce such dynamics. Sometimes, it may be cerned with human questions about evil versus
difficult to recognize that suffering expressed in this good and about eternity and infinity. Reading aloud
way in an abstract sense seeks an embrace that does with common reflective periods often provides us
not give way but is strong enough to give shelter to caregivers a possibility of getting closer to patients
this suffering, in a way that makes a becoming without getting too close, and opens the door for
movement possible. In recognizing what is bad and the suffering the patient bears.
what is difficult, horizons in the field of force are
expanded, and the possibility of bringing in a ray of In the act of caring, we strive for openness with
light and hope is opened. regard to the patient’s face and a confirmative attitude
that responds to the appeal that we can recognize that
As caregivers, we constantly ask ourselves the patient directs to us. When we as caregivers
whether the words, the language we use, bring respond to the patient’s appeal for charity, we are
promise, and how we can create linguistic foot- faced with the task of confirming the holiness of the
holds in the void by means of images and sym- other as a human being. Our constant effort is to
bols. In our effort to nourish and cleanse, that make it possible for the patient to reestablish his or
which constitutes the basic movement of tending, her dignity, accomplish his or her human mission,
and enter true communion.

CRITICAL THINKING ACTIVITIES 3 . How have you recognized the elements of
caring—faith, hope, love and tending, playing,
1. Reflect on the meaning of caritas as the ethos of and learning—in a concrete caring situation?
caring. Give examples.
a. How is caritas culture formed in a care setting?
b. How do caritative elements appear in caring? 4 . Suffering as a consequence of lack of caritative
c. What is the nature of nursing ethics based on caring is a violation of a human being’s dignity.
caritas? Think about a situation in which you saw this
occur, and consider what can be done to prevent
2. Health and suffering are each other’s preconditions. suffering related to care.
Think of what this meant in the life of a patient
you cared for recently.

POINTS FOR FURTHER STUDY n Eriksson, K. (2010). Concept determination as
part of the development of knowledge in caring
n Eriksson, K. (2007). Becoming through suffering— science. Scandinavian Journal of Caring Sciences,
The path to health and holiness. International Jour- 24, 2–11.
nal for Human Caring, 11(2), 8–16.
n Eriksson, K. (2010). Evidence—To see or not to
n Eriksson, K. (2007). The theory of caritative caring: see. Nursing Science Quarterly, 23(4), 275–279.
A vision. Nursing Science Quarterly, 20(3), 201–202.
n For further literature and information visit
n Eriksson, K. (2006). The suffering human being. our website at: http://www.abo.fi/institution/
Chicago: Nordic Studies Press. [English transla- vardvetenskap
tion of Den Lidande Människan. Stockholm: Liber
Förlag, 1994.]

186 UNIT II  Nursing Philosophies

REFERENCES science perspective. Doctoral dissertation, Turku, Finland,
Åbo Akademi University Press.]
Andersson, M. (1994). Integritet som begrepp och princip. Bondas, T., & Eriksson, K. (2001). Women’s lived experi-
En studie av ett vårdetiskt ideal i utveckling. Doktor- ences of pregnancy: A tapestry of joy and suffering.
savhandling, Turku, Finland, Åbo Akademis Förlag, Qualitative Health Research, 11(6), 824–840.
[Integrity as a concept and as a principle in health care Caspari, S. (2004). Det Gyldne snitt. Den estetiske dimensjon
ethics. Doctoral dissertation, Turku, Finland. Åbo et etisk anliggende. Doktorsavhandling, Turku, Finland:
Akademi University Press.] Åbo Academis Förlag. [The golden section. The aesthetic
dimension—a source of health. Doctoral dissertation.
Aristotle (1935). Metaphysics, X-XIV oeconomica magna Turku, Finland, Åbo Akademi University Press.]
moralia. (H. Tredennick & G. C. Armstrong, Trans.). Edlund, M. (2002). Människans värdighet—Ett grundbe-
Cambridge, (MA): Harvard University Press. grepp inom vårdvetenskapen. Doktorsavhandling, Turku,
Finland, Åbo Akademis Förlag. [Human dignity—a basic
Aristotle. (1993). Den nikomachiska etiken. Gothenburg, caring science concept. Doctoral dissertation, Turku,
Sweden: Daidalos. [The nicomachean ethics (M. Ringbom, Finland, Åbo Akademi University Press.]
Trans. & Commentary). Gothenburg, Sweden: Daidalos.] Ekebergh, M. (2001). Tillägnandet av vårdveteskaplig
kunskap. Reflexionens betydelse för lärandet. Doktor-
Aristotle. (1997). Retoriikka. Helsinki, Finland: Gaudea- savhandling, Turku, Finland, Åbo Akademis Förlag.
mus. [Rhetoric (P. Hohti, Trans.). Helsinki, Finland: [Acquiring caring science knowledge—the importance
Gaudeamus.] of reflection for learning. Doctoral dissertation, Turku,
Finland, Åbo Akademi University Press.]
Arman, M. (2003). Lidande i existens i patientens värld— Eriksson, K. (1974). Vårdprocessen (kompendium). Helsinki,
Kvinnors upplevelser av att leva med bröstcancer. Finland: Helsingfors svenska sjukvårdsinstitut. [The
Doktorsavhandling, Turku, Finland, Åbo Akademis nursing care process (Compendium). Helsinki, Finland:
Förlag. [Suffering and existence in the patient’s Helsingfors svenska sjukvårdsinstitut.]
world—Women’s experiences of living with breast Eriksson, K. (1976). Hälsa. En teoretisk och begreppsanalyt-
cancer. Doctoral dissertation, Turku, Finland, Åbo isk studie om hälsan och dess natur som mål för
Akademi University Press.] hälsovårdsedukation. Licentiatavhandling, Helsinki,
Finland: Institutionen för pedagogik, Helsingfors univer-
Arman, M., Rehnsfeldt, A., Lindholm, L., & Hamrin, E. sitet. [Health. A conceptual analysis and theoretical study
(2002). The face of suffering among women with breast of health and its nature as a goal for health care educa-
cancer—being in a field of forces. Cancer Nursing, tion. Unpublished Licentiate thesis, Helsinki, Finland:
25(2), 96–103. Department of Education, University of Helsinki.]
Eriksson, K. (1981). Vårdprocessen—En utgångspunkt för
Arman-Rehnsfeldt, M., & Rehnsfeldt, A. (2003). Vittnesbör- läroplanstänkande inom vårdutbildningen. Utvecklande
det som etisk grund i vårdandet. I K. Eriksson & U. Å. av en vårdprocessmodell samt ett läroplanstänkande
Lindström (red.), Gryning II. Klinisk vårdvetenskap utgående från vårdprocessen, n. 94. Helsinki, Finland:
(s. 109–121), Vaasa, Finland: Institutionen för vårdvetens- Helsingfors universitet, Pedagogiska Institutionen. [The
kap, Åbo Akademi. [Bearing witness as an ethical base in nursing care process—an approach to curriculum con-
caring. In K. Eriksson & U. Å. Lindström (Eds.), Dawn II. struction within nursing education. The development of a
Clinical caring science (pp. 109–121). Vaasa, Finland: model for the nursing care process and an approach for
Department of Caring Science, ÅboAkademi.] curriculum development based on the process of nursing
care (No. 94). Helsinki, Finland: Department of Educa-
Barbosa da Silva, A. (1993). Vetenskap och männiksosyn i tion, University of Helsinki.]
sjukvården: en introduktion till vetenskapsfilosofi och Eriksson, K. (1984). Hälsans idé. Stockholm: Almqvist &
vårdetik. Stockholm: Svenska hälso och sjukvårdens Wiksell. [The idea of health. Stockholm: Almqvist &
tjänstemannaförbund, (SHSTF). [Science and view of Wiksell.]
human nature in nursing: an introduction to philosophy Eriksson, K. (1985). Vårddidaktik. Stockholm: Almqvist
of science and caring ethics. Stockholm: Svenska hälso & Wiksell, [Caring didactics. Stockholm: Almqvist &
och sjukvårdens tjänstemannaförbund,(SHSTF).] Wiksell.]

Berdâev, N. A. (1990). Historiens mening: ett försök till
en filosofi om det mänskliga ödet. Skellefteå, Sweden:
Artos. [The meaning of history: an attempt at philosophy
of human fate. Skellefteå, Sweden: Artos.]

Bondas, T. (2000). Att vara med barn: en vårdvetenskaplig
studie av kvinnors upplevelser under perinatal tid.
Doktorsavhandling, Turku, Finland, Åbo Akademis
Förlag. [To be with child: a study of women’s lived
experiences during the perinatal period from a caring

Eriksson, K. (1986). Annual report. Helsingfors: Svenska CHAPTER 11  Katie Eriksson 187
Sjukvårdsinstitut. Eriksson, K., (Ed.). (1995). Mot en caritativ vårdetik

Eriksson, K. (1987a). Vårdandets idé. Stockholm: Almqvist (Vårdforskning 5/1995). Vaasa, Finland: Institutionen
& Wiksell. [The idea of caring. Stockholm: Almqvist & för vårdvetenskap, Åbo Akademi. [Toward a caritative
Wiksell.] caring ethic (Caring research 5/1995). Vaasa, Finland:
Department of Caring Science, Åbo Akademi.]
Eriksson, K. (1987b). Pausen. En beskrivning av vårdveten- Eriksson, K. (1997a). Caring, spirituality and suffering.
skapens kunskapsobjekt. Stockholm: Almqvist & Wiksell. In M. S. Roach (Ed.), Caring from the heart: the conver-
[The pause: A description of the knowledge object of gence between caring and spirituality (pp. 68–84).
caring science. Stockholm: Almqvist & Wiksell.] New York: Paulist Press.
Eriksson, K. (1997b). Perustutkimus ja käsiteanalyysi.
Eriksson, K. (1988). Vårdvetenskap som disciplin, forsknings— I M. Paunonen & J. Vehvilänen-Julkunen, Hoitotieteen
och tillämpningsområde (Vårdforskningar 1/1988). Vaasa, tutkimusmetodiikka (s. 50–75). Helsinki Porvoo,
Finland: Institutionen för vårdvetenskap, Åbo Akademi. Finland: WSOY. [Basic research and concept analysis.
[Caring science as a discipline, field of research and applica- In M. Paunonen & J. Vehvilänen-Julkunen, The re-
tion (Caring research 1/1988). Vaasa, Finland: Depart- search methodology of caring science (pp. 50–75).
ment of Caring Science, Åbo Akademi.] Helsinki Porvoo, Finland: WSOY.]
Eriksson, K. (1998). Understanding the world of the patient,
Eriksson, K. (1989). Caring paradigms. A study of the ori- the suffering human being: the new clinical paradigm
gins and the development of caring paradigms among from nursing to caring. In C. E. Guzzetta (Ed.), Essential
nursing students. Scandinavian Journal of Caring Sci- readings in holistic nursing (pp. 3–9). Gaithersburg,
ences, 3(4), 169–176. (MD): Aspen.
Eriksson, (1999, November). Teoriutveckling inom vård-
Eriksson, K. (1990). Pro Caritate. En lägesbestämning av car- vetenskapen. Human vetenskaplig angreppspunkt. Stock-
itativ vård. Vårdforskningar 2/1990. Vaasa, Finland: In- holm: Nordisk Akademi för Sykepleievitenskap, Kon-
stitutionen för vårdvetenskap, Åbo Akademi. [Caritative gress i Stockholm. [Theory development in caring science.
caring—a positional analysis. Vaasa, Finland: Depart- A humanistic approach. Stockholm: Nordisk Akademi
ment of Caring Science, Åbo Akademi.] för Sykepleievitenskap, Kongress i Stockholm.]
Eriksson, K. (2001). Vårdvetenskap som akademisk disciplin
Eriksson, K. (1991). Broar. Introduktion i vårdvetenskaplig (Vårdforskning 7/2001). Vaasa, Finland: Institutionen
metod. Vaasa, Finland: Institutionen för vårdvetenskap, för vårdvetenskap, Åbo Akademi. [Caring science as an
Åbo Akademi. [Bridges. Introduction to the methods of academic discipline (Caring research 7/2001). Vaasa,
caring science (test ed.). Vaasa, Finland: Department of Finland: Department of Caring Science, Åbo Akademi.]
Caring Science, Åbo Akademi.] Eriksson, K. (2002). Caring science in a new key. Nursing
Science Quarterly, 15(1), 61–65.
Eriksson, K. (1992a). The alleviation of suffering—the idea Eriksson, K. (2003). Ethos. I K. Eriksson & U. Å. Lindström
of caring. Scandinavian Journal of Caring Sciences, 6(2), (red.), Gryning II. Klinisk vårdvetenskap (s. 21–34).
119–123. Vaasa, Finland: Institutionen för vårdvetenskap,
Åbo Akademi. [Ethos. In K. Eriksson & U. Å. Lindström
Eriksson, K. (1992b). Different forms of caring commu- (Eds.), Dawn II. Clinical caring science (pp. 21–34). Vaasa,
nion. Nursing Science Quarterly, 5,93. Finland: Department of Caring Science, Åbo Akademi.]
Eriksson, K., Bondas-Salonen, T., Fagerström, L., Herberts,
Eriksson, K. (1992c). Nursing: the caring practice “being S., & Lindholm, L. (1990). Den mångdimensionella
there.” In D. Gaut (Ed.), The practice of caring in nurs- hälsan—En pilotstudie över uppfattningar bland patien-
ing (pp. 201–210). New York: National League for ter, skolungdomar och lärare (Projektrapport). Vaasa,
Nursing Press. Finland: Vasa Sjukvårdsdistrikt kf. och Institutionen
för vårdvetenskap, Åbo Akademi. [Multidimensional
Eriksson, K. (1993). Lidandets idé. I K. Eriksson (red.), health—A pilot study of how patients, school students,
Möten med lidanden. Vårdforskning 4/1993 (s. 1–27). and teachers experience health (Project Rep. 1). Vaasa,
Vaasa, Finland: Institutionen för vårdvetenskap, Åbo Finland: Vasa Sjukvårdsdistrikt kf. och Institutionen för
Akademi. [The idea of suffering. In K. Eriksson (Ed.), vårdvetenskap, Åbo Akademi.]
Encounters with suffering (pp. 1–27). Vaasa, Finland: Eriksson, K., & Herberts, S. (1992). Den mångdimensionella
Department of Caring Science, Åbo Akademi.] hälsan. En studie av hälsobilden hos sjukvårdsledare och

Eriksson, K. (1994a). Den lidande människan. Stockholm:
Liber Förlag. [The suffering human being. Stockholm:
Liber Förlag.] [English translation published in 2006
by Nordic Studies Press, Chicago.]

Eriksson, K. (1994b). Theories of caring as health. In D. Gaut
& A. Boykin (Eds.), Caring as healing: Renewal through
hope (pp. 3–20). New York: National League for Nursing
Press.

188 UNIT II  Nursing Philosophies Fredriksson, L., & Eriksson, K. (2001). The patient’s narra-
sjukvårdspersonal (Projektrapport 2). Vaasa, Finland: tive of suffering—A path to health? An interpretative
Vasa sjukvårdsdistrikt kf. och Institutionen för vård- research synthesis on narrative understanding. Scandi-
vetenskap, Åbo Akademi. [The multidimensional health. navian Journal of Caring Sciences, 15(1), 3–11.
A study of the view of health among health care leaders
and health care personnel (Project Rep. 2). Vaasa, Fin- Fredriksson, L., & Eriksson, K. (2003). The ethics of the
land: Vasa sjukvårdsdistrikt kf. och Institutionen för caring conversation. Nursing Ethics, 10(2), 138–148.
vårdvetenskap, Åbo Akademi.]
Fredriksson, L., & Lindström, U. Å. (2002). Caring
Eriksson, K., & Lindström, U. Å. (1997). Abduction—A conversations—Psychiatric patients’ narratives about
way to deeper understanding of the world of caring. suffering. Journal of Advanced Nursing, 40(4), 396–404.
Scandinavian Journal of Caring Sciences, 11(4), 195–198.
Gadamer, H-G. (1994). Truth and method (2nd rev. ed.,
Eriksson, K., & Lindström, U. Å. (2000). Siktet, sökandet, J. Weinsheimer & D. G. Marshall, Trans.). New York:
slutandet—Om den vårdvetenskapliga kunskapen. Continuum. [Original work published 1960.]
I K. Eriksson & U. Å. Lindström (red.), Gryning—En
vårdvetenskaplig antologi (s. 5–18). Vaasa, Finland: Gadamer, H-G. (2000). Teoriens lovprisning, Århus: Sys-
Institutionen för vårdvetenskap, Åbo Akademi. [In teme. [Praise the theory. New Haven: Yale University
the prospect of, searching for, and ending of—The Press, 1998.] [German orig: Lob der Theorie, 3.
caring science knowledge. In K. Eriksson & U. Å. Auflage, 1991.]
Lindström (Eds.), Dawn. An anthology of caring science
(pp. 5–18). Vaasa, Finland: Department of Caring Sci- Gustafsson, L-K. (2008). Försoning ur ett vårdvetenskapligt
ence, Åbo Akademi.] perspektiv. Doktorsavhandling, Turku, Finland, Åbo
Akademis förlag. [Reconciliation—From a caring perspec-
Eriksson, K., & Lindström, U. Å. (2003). Klinisk vårdveten- tive. Doctoral dissertation, Turku, Finland, Åbo Akademi
skap. I K. Eriksson & U. Å. Lindström (red.), Gryning II. University Press.]
Klinisk vårdvetenskap (s. 3–20). Vaasa, Finland: Institu-
tionen för vårdvetenskap, Åbo Akademi. [Clinical caring Hilli, Y. (2007). Hemmet som ethos. En idéhistorisk studie
science. In K. Eriksson & U. Å. Lindström (Eds.), Dawn II. av hur hemmet som ethos blev evident i hälsosysterns
Clinical caring science (pp. 3–20). Vaasa, Finland: Depart- vårdande under 1900-talets första hälft. Doktorsavhan-
ment of Caring Science, Åbo Akademi.] dling, Turku, Finland, Åbo Akademis Förlag. [The
home as ethos. A history of ideas study of how the home
Eriksson, K., & Nordman, T. (2004). Trojanska hästen II. as ethos became evident in public health nurses’ caring
Utvecklande av evidensbaserade vårdande kulturer. during the first half of the 20th century. Doctoral disser-
Vaasa, Finland: Institutionen för vårdvetenskap, tation, Turku, Finland, Åbo Akademi University Press.]
Åbo Akademi. [Trojan Horse II. The development of
evidence-based caring cultures. Vaasa, Finland; The Kaila, E. (1939). Den mänskliga kunskapen: vad den är och
Department of Caring Science, Åbo Akademi vad den icke är. Helsinki, Finland: Söderström. [Human
University.] knowledge: What it is and what it is not (G. H. von
Wright, Trans.). Helsinki, Finland: Söderström.]
Eriksson K., Nordman T., & Myllymäki, I., (1999). Den
trojanska hästen. Evidensbaserat vårdande och vårdar- Kasén, A. (2002). Den vårdande relationen. Doktorsavhan-
bete ur ett vårdvetenskapligt perspektiv (Rapport 1). dling, Turku, Finland, Åbo Akademis Förlag. [The car-
Institutionen för vårdvetenskap. Vaasa, Finland: Åbo ing relationship. Doctoral dissertation Turku, Finland,
Akademi; Helsingfors universitetscentralsjukhus & Åbo Akademi University Press.]
Vasa sjukvårdsdistrikt. [The Trojan horse. Evidence-
based caring and nursing care in a caring science Kierkegaard, S. (1943). Antingen—Eller [Orig. 1843.
perspective. (Report). Department of Caring Science. Enten—Eller.]. Utgiver under pseudonymen Victor
Vaasa, Finland: Åbo Akademi; Helsingfors univer- Eremita. Köpenhamn: Meyer. [Either/or. Princeton,
sitetscentralsjukhus & Vasa sjukvårdsdistrikt.] (NJ): Princeton University Press, 1987. [Original
work published 1843.]
Fagerström, L. (1999). The patients’ caring needs. To un-
derstand and measure the unmeasurable. Doctoral Koort, P. (1975). Semantisk analys och konfigurations-
dissertation. (Turku, Finland, Åbo Akademi analys. Lund, Sweden: Studentlitteratur. [Semantic
University Press.) analysis and analysis of configuration. Lund, Sweden:
Studentlitteratur.]
Fredriksson, L. (2003). Det vårdande samtalet. Doktor-
savhandling, Åbo Akademis Förlag, Turku, Finland. Kuhn, T. (1971). The structure of scientific revolutions.
[The caring conversation. Doctoral dissertation, Turku, Chicago: University of Chicago Press.
Finland, Åbo Akademi University Press.]
Kurtén, T. (1987). Grunder för en kontextuell teologi: ett
wittgensteinskt sätt att närma sig teologin I diskussion
med Anders Jeffner. Turku, Finland: Åbo Akademis För-
lag. [Bases for a contextual theology: a Wittgensteinian

way of approaching theology in a discussion with Anders CHAPTER 11  Katie Eriksson 189
Jeffner. Turku, Finland: Åbo Akademi University Press.] Lindwall, L. (2004). Kroppen som bärare av hälsa och lidande.
Kärkkäinen, O., & Eriksson, K. (2003). Evaluation of patient
records as a part of developing a nursing care classifica- Doktorsavhandling, Turku, Finland, Åbo Akademis Förlag.
tion. Journal of Clinical Nursing, 12(2), 198–205. [The body as a carrier of health and suffering. Doctoral dis-
Kärkkäinen, O., & Eriksson, K. (2004). Structuring the sertation, Turku, Finland, Åbo Akademi University Press.]
documentation of nursing care on the basis of a theo- Lukander, E. (1995). Developing and testing a method:
retical process model. Scandinavian Journal of Caring Nursing audit, for evaluation of nursing care. Licentiate
Sciences, 18(2), 229–236. thesis, Kuopion yliopisto, Kuopio, Finland.
Lanara, V. (1981). Heroism as a nursing value. Athens, Martinsen, K., (Ed.). (1996). Fenomenologi og omsorg.
Greece: Sisterhood Evniki. Oslo, Norway: TANO. [Phenomenology and care.
Langer, S. K. (1942). Filosofi i en ny tonart. Stockholm: Oslo, Norway: TANO.]
Geber. [Philosophy in a new key. Stockholm: Geber.] Martinsen, K., & Eriksson, K. (2009). Å se og Å innse.
Lassenius, E. (2005). Rummet i vårdandets värld. Doktor- Oslo: Akribi.
savhandling, Turku, Finland, Åbo Akademis Förlag. Nilsson, B. (2004). Savnets tone i ensomhetens melodi.
[The space in the world of caring. Doctoral dissertation, Ensomhet hos aleneboende personer med alvorlig
Turku, Finland, Åbo Akademi University Press.] psykisk lidelse. Doktorsavhandling, Turku, Finland,
Lévinas, E. (1985). Ethics and infinity. Pittsburgh: Åbo Akademis Förlag. [The tune of want in the loneli-
Duquesne University Press. ness melody. Doctoral dissertation, Turku, Finland,
Lévinas, E. (1988). Etik och oändlighet. Stockholm-Lund: Åbo Akademi University Press.]
Symposion. [Ethics and infinity. Stockholm-Lund: Nyback, M-H. (2008). Generic and professional caring in
Symposium.] a Chinese setting—an ethnographic study. Doctoral
Lévinas, E. (1989). The Lévinas reader (S. Hand, Ed.). Oxford: dissertation, Turku, Finland, Åbo Akademi University
Blackwell. Press.
Lindholm, L. (1998). Den unga människans hälsa och lidande. Nygren, A. (1966). Eros och agapé. Stockholm: Aldus Bon-
Doktorsavhandling, Vaasa, Finland. Institutionen för niers. [Eros and agapé. Stockholm: Aldus Bonniers.]
vårdvetenskap, Åbo Akademi. [The young person’s health Nygren, A. (1972). Meaning and method: prolegomena to a
and suffering. Doctoral dissertation, Vaasa, Finland. scientific philosophy of religion and a scientific theology.
Åbo Akademi, Department of Caring Science.] London: Epworth Press.
Lindholm, L., & Eriksson, K. (1993). To understand and Nåden, D. (1998). Når sykepleie er kunstutøvelse. En under-
to alleviate suffering in a caring culture. Journal of søkelse av noen nødvendige forutsetninger for sykepleie
Advanced Nursing, 18, 1354–1361. som kunst. Doktorsavhandling, Vaasa, Finland. Institu-
Lindholm, L., & Eriksson, K. (1998). The dialectic of tionen för vårdvetenskap, Åbo Akademi. [When caring
health and suffering: An ontological perspective on is an exercise of art. An examination of some necessary
young people’s health. Qualitative Health Research, 8(4), preconditions of nursing as art. Doctoral dissertation,
513–525.Lindholm, L., Nieminen, A-L., Mäkelä, C., & Department of Caring Science, Åbo Akademi, Vaasa,
Rantanen-Siljamäki, S. (2004). Significant others—A Finland.]
source of strength in the care of women with breast can- Näsman, Y. (2010). Hjärtats vanor, tankens välvilja och
cer. Manuscript submitted for publication. handens gärning—dygd som vårdetiskt grundbegrepp.
Lindholm, T. (2008). Kaikki se kärsii? Parisuhdeväkivalta, Doktorsavhandling, Turku, Finland, Åbo Akademis för-
kärsimys ja sen lievittäminen naisten ja miesten lag. [Habits of the heart, benevolence of the mind, and
näkökulmasta. Doktorsavhandling, Turku, Finland, deeds of the hand—Virtue as a basic concept in caring
Åbo Akademis förlag. [Love endures all things? Vio- ethics. Doctoral dissertation, Turku, Finland, Åbo Aka-
lence between spouses, suffering and alleviation of suf- demi University Press.]
fering from the viewpoint of women and men. Doctoral Pascal, B. (1971). Tankar. Uddevalla, Sweden: Bohusläningens
dissertation, Turku, Finland, Åbo Akademi University AB. [Thoughts. Uddevalla, Sweden: Bohusläningens AB.]
Press.] Peirce, C. S. (1990). Pragmatism och kosmologi. Valda up-
Lindström, U. Å. (1992). De psykiatriska specialsjukskötar- psatser. Gothenburg, Sweden: Daidalos. [Pragmatism
nas yrkesparadigm. Doktorsavhandling, Turku, Finland. and cosmology (Chosen essays). Gothenburg, Sweden:
Åbo Akademis Förlag. [The professional paradigm of the Daidalos.]
qualified psychiatric nurses.Doctoral dissertation, Turku, Popper, K. R. (1997). Popper i urval av Miller. Kunskapsteori,
Finland, Åbo Akademi University Press.] vetenskapsteori. Stockholm: Thales. [Popper in selection
of Miller. Theory of knowledge and theory of science.
Stockholm: Thales.]

190 UNIT II  Nursing Philosophies (BeNMDS) kulttuurinen adaptio Suomeen. Doktor-
Råholm, M-B. (2003). I kampens och modets dialektik. savhandling, Väitöskirja, Kuopion yliopisto, Kuopio,
Finland. [Methods to describe nursing with uniform
Doktorsavhandling, Åbo Akademis Förlag, Turku, language: The cross-cultural adaptation process of the
Finland. [In the dialectic of struggle and courage. Disser- Belgium Nursing Minimum Data Set in Finland. Doc-
tation, Åbo Akademi University Press, Turku, Finland.] toral dissertation, Kuopio University, Kuopio, Finland.]
Råholm, M-B., & Lindholm, L. (1999). Being in the world von Post, I. (1999). Professionell naturlig vård ur anestesi
of the suffering patient: A challenge to nursing ethics. och operationassjuksköterskors perspektiv. Doktor-
Nursing Ethics, 6, 528–539. savhandling, Åbo Akademis Förlag, Turku, Finland.
Råholm, M-B., Lindholm, L., & Eriksson, K. (2002). Grasping [Professional natural care from the perspective of nurse
the essence of the spiritual dimension reflected through anesthetists and operating room nurses. Doctoral disser-
the horizon of suffering—An interpretative research syn- tation, Turku, Finland, Åbo Akademi University Press.]
thesis. Australian Journal of Holistic Nursing, 9, 4–12. von Wright, G. H. (1986). Vetenskapen och förnuftet. Helsinki,
Rundqvist, E. (2004). Makt som fullmakt. Ett vårdvetens- Finland: Söderström. [Science and reason. Helsinki,
kapligt perspektiv. Doktorsavhandling, Åbo Akademis Finland: Söderström.]
Förlag, Turku, Finland. [Power as authority. A caring Wallinvirta, E. (2011). Ansvar som klangbotten i vårdan-
science perspective. Doctoral dissertation, Åbo Akademi dets meningssammanhang. Doktorsavhandling, Turku,
University Press, Turku, Finland.] Finland, Åbo Akademis förlag. [Responsibility as
Sivonen, K. (2000). Vården och det andliga. En bestämning sounding board in the caring’s context of meaning.
av begreppet ‘andlig’ ur ett vårdvetenskapligt perspektiv. Doctoral dissertation, Turku, Finland, Åbo Akademi
Doktorsavhandling, Turku, Finland, Åbo Akademis University Press.]
Förlag. [Care and the spiritual dimension. A definition of Wiklund, L. (2000). Lidandet som kamp och drama. Dok-
the concept of “spiritual” in a caring science perspective. torsavhandling, Turku, Finland, Åbo Akademis Förlag.
Doctoral dissertation, Turku, Finland, Åbo Akademi [Suffering as struggle and as drama. Doctoral disserta-
University Press.] tion, Turku, Finland, Åbo Akademi University Press.]
St. Augustine, A. (1957). Bekännelser. Stockholm: Söderström. Wingren, G. (1996). Predikan: en principiell studie. Lund,
[Confessions. Stockholm: Söderström.] Sweden: Gleerup. [The sermon: a study based on princi-
Törnebohm, H. (1978). Paradigm i vetenskapsteorin (Del 2. ples. Lund, Sweden: Gleerup.] [Original work
Rapport nr. 100). Gothenburg, Sweden: Institutionen published 1960.]
för vetenskapsteori, Göteborgs universitet. [Paradigms Wärnå, C. (2002). Dygd och hälsa. Doktorsavhandling,
in the theory of science (Part 2 Report nr. 100). Gothen- Turku, Finland, Åbo Akademis Förlag. [Virtue and
burg, Sweden: Institutionen för vetenskapsteori, health. Doctoral dissertation, Turku, Finland,
Göteborgs universitet.] Åbo Akademi University Press.]
Turtiainen, A-M. (1999). Hoitotyön käytännön kuvaamisen
yhtenäistäminen: Belgialaisen hoitotyön minimitiedoston

BIBLIOGRAPHY strategic plans. International Journal of Nursing Stud-
ies, 43, 851–859.
Primary Sources Caspari, S., Nåden, D., & Eriksson, K. (2007). Why not ask
Articles in Scientific Journals with Referee the patient? An evaluation of the aesthetic surround-
Practice ings in hospital by patients. Quality Management in
Arman, M., Rehnsfeldt, A., Lindholm, L., Hamrin, E., & Health Care, 16(3), 280–292.
Eriksson, K. (1976). Nursing—Skilled work or a profes-
Eriksson, K. (2004). Suffering related to health care: sion? International Nursing Review, 23(4), 118–120.
A study of breast cancer patients’ experiences. Interna- Eriksson, K. (1979). Semantiska och kulturella aspekter på
tional Journal of Nursing Practice, 10(6), 248–256. hälsobegreppet. Finska Läkaresällskapets handlingar,
Bondas, T., & Eriksson, K. (2001). Women’s lived experi- 74–81. [Semantic and cultural aspects of the concept of
ences of pregnancy: A tapestry of joy and suffering. health. Finska Läkaresällskapets handlingar, 74–81.]
Qualitative Health Research, 11(6), 824–840. Eriksson, K. (1980). Hoitotieteen loogiset ja tieteenteoreet-
Caspari, S., Eriksson, K., & Nåden, D. (2011). The impor- tiset perusteet. Sosiaalinen aikakauskirja, 14(5), 6–10.
tance of aesthetic surroundings: A study interviewing [The theory of science and logical basics of caring sci-
experts within different aesthetic fields. Scandinavian ence. Sosiaalinen aikakauskirja, 14(5), 6–10.
Journal of Caring Sciences, 25(1), 134–142.
Caspari, S., Nåden, D., & Eriksson, K. (2006). The aes-
thetic dimension in hospitals—An investigation into

Eriksson, K. (1980). Hoitotieteen teoreettisista malleista, CHAPTER 11  Katie Eriksson 191
käsitejärjestelmistä ja niiden merkityksestä alan kehit- Eriksson, K. (2002). Caring science in a new key. Nursing
tämisessä. Sosiaalilääketieteellinen aikakauslehti, 17(2),
66–70. [The importance of caring scientific theoretical Science Quarterly, 15(1), 61–65.
models and concept systems for the development of Eriksson, K. (2007a). Becoming through suffering—The
the science. Sosiaalilääketieteellinen aikakauslehti, 17(2),
66–70.] path to health and holiness. International Journal for
Human Caring, 11(2), 8–16.
Eriksson, K. (1982). Sjukskötarnas strävan efter högs- Eriksson, K. (2007b). The theory of caritative caring: A
koleutbildning. Kasvatus, 13(3), 192–194. [The vision. Nursing Science Quarterly, 20(3), 201–202.
nurses strive for a university education. Kasvatus, Eriksson, K. (2010). Concept determination as part of the
13(3), 192–194.] development of knowledge in caring science. Scandina-
vian Journal of Caring Sciences, 24, 2–11.
Eriksson, K. (1989). Caring paradigms. A study of the ori- Eriksson, K. (2010). Evidence – To see or not to see. Nursing
gins and the development of caring paradigms among Science Quarterly, 23(4), 275–279.
nursing students. Scandinavian Journal of Caring Sci- Eriksson, K., Bondas, T., Lindholm, L., Kasén, A., &
ences, 3(4), 169–176. Matilainen, D. (2002). Den vårdvetenskapliga for-
skningstraditionen vid Institutionen för vårdvetenskap,
Eriksson, K. (1989). Det finns en gemensam substans i allt Åbo Akademi. Hoitotiede, 14(6), 307–315. [The tradi-
vårdandet. Vård i Norden, 15(2), 27–28. [There is a tion of research at the Department of Caring Science,
common substance in all caring. Nordic Journal of Åbo Akademi University. Journal of Nursing Science,
Nursing Research and Clinical Studies, 15(2), 27–28.] 14(6), 307–315.]
Eriksson, K., Herberts, S., & Lindholm, L. (1994). Bilder
Eriksson, K. (1989). Motivforskning inom vårdvetens- av lidande—Lidande i belysning av aktuell vårdvetens-
kapen. En beskrivning av vårdvetenskapens grundmotiv. kaplig forskning. Hoitotiede, 4, 155–162. [Views of
Hoitotiede, 1(2), 61–67. [Motive research within caring suffering—Suffering in the light of current research within
science. A description of the basic motive in caring caring science. Journal of Nursing Science, 4, 155–162.]
science. Journal of Nursing Science, 1(2), 61–67.] Eriksson, K., Leino-Kilpi, H., & Vehviläinen-Julkunen, K.
(2008). Hoitotiede ja tiede-etiikka. Hoitotiede, 20(6),
Eriksson, K. (1990). Nursing science in a Nordic perspec- 295–303.
tive. Systematic and contextual caring science. A study Eriksson, K., & Lindström, U. Å. (1997). Abduction—
of the basic motive of caring and context. Scandinavian A way to deeper understanding of the world of
Journal of Caring Sciences, 4(1), 3–5. caring. Scandinavian Journal of Caring Sciences,
11(4), 195–198.
Eriksson, K. (1992). Different forms of caring communion. Eriksson, K., & Lindström, U. Å. (1999). Abduktion och
Nursing Science Quarterly, 5, 93. pragmatism—Två vägar till framsteg inom vårdvetens-
kapen. Hoitotiede, 11(5), 292–299. [Abduction and
Eriksson, K. (1992). The alleviation of suffering—The idea pragmatism—Two ways to progress within caring sci-
of caring. Scandinavian Journal of Caring Sciences, 6(2), ence. Journal of Nursing Science, 11(5), 292–299.]
119–123. Eriksson, K., & Lindström, U. Å. (1999). En vetenskapste-
ori för vårdvetenskapen. Hoitotiede, 11(6), 358–364.
Eriksson, K. (1994). Hälsovårdskandidatutbildningen vid [A theory of science for caring science. Journal of
Helsingfors universitet—Historisk tillbakablick och Nursing Science, 11(6), 358–364.]
visioner. Hoitotiede, 3, 122–126. [The bachelor’s degree Eriksson, K., & Lindström, U. Å. (1999). The fundamental
in health care at Helsinki University—A historical idea of quality assurance. International Journal for Human
retrospect and visions. Journal of Nursing Science, 3, Caring, 3(3), 21–27.
122–126.] Eriksson, K., & von Post, I. (1999). A hermeneutic textual
analysis of suffering and caring in the peri-operative
Eriksson, K. (1995). Ars moriendi är ars vivendi. Finsk tid- context. Journal of Advanced Nursing, 30(4), 983–989.
skrift, 10, 641–645. [Ars moriendi is ars vivendi. Finsk Fagerström, L., Eriksson, K., & Bergbom Engberg, I.
tidskrift, 10, 641–645.] (1998). The patient’s perceived caring needs as a
message of suffering. Journal of Advanced Nursing,
Eriksson, K. (1995). Teologi og bioetik. Vård i Norden, 1, 28(5), 978–987.
33. [Theology and bio-ethics. Nordic Journal of Nursing Fagerström, L., Eriksson, K., & Bergbom Engberg, I. (1999).
Research and Clinical Studies, 1, 33.] The patient’s perceived caring needs—Measuring the

Eriksson, K. (1997). Understanding the world of the patient,
the suffering human being—The new clinical paradigm
from nursing to caring. Advanced Practice Nursing Quar-
terly, 3(1), 8–13.

Eriksson, K. (1998). Hälsans tragedy. Finsk tidskrift, 10,
590–599. [The tragedy of health. Finsk tidskrift, 10,
590–599.]

192 UNIT II  Nursing Philosophies Nåden, D., & Eriksson, K. (2000). The phenomenon of
unmeasurable. International Journal of Nursing Practice, confirmation—An aspect of nursing as an art. Interna-
5(4), 199–208. tional Journal for Human Caring, 4(3), 23–28.

Fredriksson, L., & Eriksson, K. (2001). The patient’s narra- Nåden, D., & Eriksson, K. (2002). Encounter: A funda-
tive of suffering—A path to health? An interpretative mental category of nursing as an art. International Jour-
research synthesis on narrative understanding. Scandi- nal for Human Caring, 6(1), 34–40.
navian Journal of Caring Sciences, 15(1), 3–11.
Nåden, D., & Eriksson, K. (2003). Semantisk begrepsanalyse—
Fredriksson, L., & Eriksson, K. (2003). The ethics of the Et grunnleggende aspekt i en disiplins teoriutvikling.
caring conversation. Nursing Ethics, 10(2),138–148. Vård i Norden, 23(1), 21–26. [Semantic concept analysis—
A fundamental aspect in the theory development of a
Herberts, S., & Eriksson, K. (1995). Nursing leaders’ and discipline. Nordic Journal of Nursing Research and
nurses’ view of health. Journal of Advanced Nursing, 22, Clinical Studies, 23(1), 21–26.]
868–878.
Nåden, D., & Eriksson, K. (2004a). Understanding the im-
Kärkkäinen, O., Bondas, T., & Eriksson, K. (2005). Docu- portance of values and moral attitudes in nursing care
mentation of individualized patient care: a qualitative in preserving human dignity. Nursing Science Quarterly,
metasynthesis. Nursing Ethics, 12(2), 123–132. 17(1), 86–91.

Kärkkäinen, O., & Eriksson, K. (2003). Evaluation of patient Nåden, D., & Eriksson, K. (2004b). Values and moral atti-
records as a part of developing a nursing care classifica- tudes in nursing care. Understanding the patient perspec-
tion. Journal of Clinical Nursing, 12(2), 198–205. tive. Norsk Tidskrift for Sygepleieforskning, 6(1), 3–17.

Kärkkäinen, O., & Eriksson, K. (2004a). A theoretical Näsman, Y., Nyström, L., & Eriksson, K.(2011). Virtue, eth-
approach to documentation of care. Nursing Science ics and quality of care. International Journal for Human
Quarterly, 17(3), 2–6. Caring, 15(3), 74.

Kärkkäinen, O., & Eriksson, K. (2004b). Structuring the Rehnsfeldt, A., & Eriksson, K. (2004). The progression of
documentation on nursing care on the basis of a theo- suffering implies alleviated suffering. Scandinavian
retical caring process model. Scandinavian Journal of Journal of Caring Sciences, 18(3), 264–272.
Caring Sciences, 18(2), 229–236.
Roxberg, Å., Rehnsfeldt, A., Fridlund, B., & Eriksson, K.
Kärkkäinen, O., & Eriksson, K. (2005). Recording the con- (2008). The meaning of consolation as experienced by
tent of the caring process. Journal of Nursing Manage- nurses in a home-care setting. Journal of Clinical Nurs-
ment, 13, 202–208. ing, 17(8), 1079–1087.

Levy-Malmberg, R., & Eriksson, K. (2010). Legitimizing Rudolfsson, G., von Post, I., & Eriksson, K. (2007). The
basic research by evaluating quality. Nursing Ethics, development of caring in the perioperative culture—
17(1), 107–116. Nurse leaders’ perspective on the struggle to retain
sight of the patient. Nursing Administration Quarterly,
Levy-Malmberg, R., Eriksson, K., & Lindholm, L. (2008). 31(4), 312–324.
Caritas—Caring as an ethical conduct. Scandinavian
Journal of Caring Sciences, 22(4), 662–667. Rudolfsson, G., von Post, I., & Eriksson, K. (2007). The
expression of caring within the perioperative dialogue:
Lindholm, L., & Eriksson, K. (1993). To understand and to a hermeneutic study. International Journal of Nursing
alleviate suffering in a caring culture. Journal of Advanced Studies, 44, 905–915.
Nursing, 18, 1354–1361.
Rykkje, L., Eriksson, K., & Råholm, M-B. (2011). A qualita-
Lindholm, L., & Eriksson, K. (1998). The dialectic of tive metasynthesis of spirituality from a caring science
health and suffering: An ontological perspective on perspective. International Journal for Human Caring,
young people’s health. Qualitative Health Research, 8(4), 15(4), 40–53.
513–525.
Råholm, M-B., & Eriksson, K. (2001). Call to life: Explor-
Lindholm, T., & Eriksson, K. (2011). Caring of the patients ing the spiritual dimension as a dialectic between
suffering from violence between spouses – Intersectional suffering and desire experienced by coronary bypass
encounters. International Journal for Human Caring, patients. International Journal for Human Caring,
15(3), 72. 5(1), 14–20.

Lindwall, I., von Post, I., & Eriksson, K. (2010). Clinical Råholm, M-B., Lindholm, L., & Eriksson, K. (2002). Grasp-
research with a hermeneutical design and an element ing the essence of the spiritual dimension reflected
of application. International Journal of Qualitative through the horizon of suffering: An interpretative
methods, 9(2), 172–186. research synthesis. The Australian Journal of Holistic
Nursing, 9(1), 4–13.
Nordman, T., Santavirta, N., & Eriksson, K. (2008). Devel-
oping an instrument to evaluate suffering related to
care. Scandinavian Journal of Caring Sciences, 22(4),
608–615.

CHAPTER 11  Katie Eriksson 193

Sivonen, K., Kasén, A., & Eriksson, K. (2010). Semantic Finland: Sairaanhoitajien Koulutussäätiö. [The model—A
analysis according to Peep Koort—A substance-oriented way of describing the act of nursing care. In Health care
research methodology. Scandinavian Journal of Caring yearbook XV (pp. 189–225). Helsinki, Finland: Sairaan-
Sciences, 24, 12–20. hoitajien Koulutussäätiö.]
Eriksson, K. (1982). Den vårdvetenskapscentrerade
von Post, I., & Eriksson, K. (2000). The ideal and practice läroplanen—Ett alternativ för dagens vårdutbildning.
concepts of “professional nursing care.” International I Sairaanhoidon vuosikirja XIX (s. 173–187). Helsinki,
Journal for Human Caring, 4(1), 14–22. Finland: Sairaanhoitajien Koulutussäätiö. [The caring
science centered curriculum—An alternative for
Wikberg, A., & Eriksson, K. (2008). Intercultural caring— health education today. In Health care yearbook XIX
An abductive model. Scandinavian Journal of Caring (pp. 173–187). Helsinki, Finland: Sairaanhoitajien
Sciences, 22(3), 485–496. Koulutussäätiö.]
Eriksson, K. (1983). Den fullvuxna insulindiabetikern i
Wiklund-Gustin, L., & Eriksson, K. (2009). The drama of hälsovårdens vårdprocess. I Sairaanhoidon vuosikirja
suffering as narrated by patients who have undergone XIX (s. 428–430). Helsinki, Finland: Sairaanhoitajien
coronary bypass surgery. International Journal for Human Koulutussäätiö. [The adult insulin-dependent diabetic
Caring, 13(4), 17–25. in the health care nursing process. In Health care year-
book XIX (pp. 428–430). Helsinki, Finland:
Wikström-Grotell, C., Lindholm, L., & Eriksson, K. (2002). Sairaanhoitajien Koulutussäätiö.]
Det mångdimensionella rörelsebegreppet i fysioterapin— Eriksson, K. (1983). Vårdområdet finner sin profil—Den
En kontextuell analys. Nordisk Fysioterapi, 6, 146–184. vårdvetenskapliga eran har inlets. I Epione, Jubileums-
[The multidimensional concept of movement in skrift 1898–1983 (s. 12–17). [The area of caring finds its
physiotherapy—A contextual analysis. Nordisk profile—The caring science era has begun. In Epione,
Fysioterapi, 6, 146–184.] Jubilee-script 1898–1983 (pp. 12–17). Helsinki, Finland:
SSY-Sjuksköterskeföreningen i Finland.]
Wärnå, C., Lindholm, L., & Eriksson, K. (2007). Virtue Eriksson, K. (1986). Hoito, Caring—Hoitotyön primaari
and health—finding meaning and joy in working life. substanssi. Puheenvuoro 2. I T. Martikainen & K. Man-
Scandinavian Journal of Caring Sciences, 21(2), 191–198. ninen (red.), Hoitotyö ja koulutus (s. 17–41). Hämeen-
linna, Finland: Sairaanhoitajien Koulutussäätiö.
Wärnå, C., Lindholm, L., & Eriksson, K. (2008). Virtue [Caring—The primary substance of nursing. Speech
and health—Describing virtue as a path to the inner 2. In T. Martikainen & K. Manninen (Eds.), Nursing
domain of health. International Journal for Human and education (pp. 17–41). Hämeenlinna, Finland:
Caring, 12(1), 17–24. Sairaanhoitajien Koulutussäätiö.]
Eriksson, K. (1987). Vårdvetenskapen som humanistisk
Articles in Compilation Works and vetenskap. I Hoitotiede vuosikirja (s. 68–77) [Caring
Proceedings with Referee Practice science as a humanistic science. Journal of Nursing
Compilation Works Science Yearbook, 68–77.]
Eriksson, K. (1971). En analys av sjuksköterskeutbildnin- Eriksson, K. (1988). Vårdandets idé och ursprung.
I Panakeia. Vårdvetenskaplig årsbok (s. 17–35). Stock-
gen utgående från en utbildningsteknologisk model. holm: Almqvist & Wiksell. [The origin and idea of car-
I Sairaanhoidon vuosikirja VIII (s. 54–77). Helsinki, ing. In Panakeia. Caring science yearbook (pp. 17–35).
Finland: Sairaanhoitajien Koulutussäätiö. [An analysis Stockholm: Almqvist & Wiksell.]
of nursing education from an educational-technological Eriksson, K. (1989). Ammatillisuus hoitamisessa. I Hoitoopin
model. In Health care yearbook VIII (pp. 54–77). perusteet (2: 2 yppl., s. 125–129). Vaasa, Finland: Sairaan-
Helsinki, Finland: Sairaanhoitajien Koulutussäätiö.] hoitajien Koulutussäätiö. [Professionalism in caring. In
Eriksson, K. (1974). Sairaanhoidon kehittäminen oppi- The basics of nursing science (2nd ed., pp. 125–129).
aineena. I Sairaanhoidon vuosikirja XI (s. 9–21). Helsinki, Vaasa, Finland: Sairaanhoitajien Koulutussäätiö.]
Finland: Sairaanhoitajien Koulutussäätiö. [The develop- Eriksson, K. (1990). Framtidsvisioner—om utvecklingen
ment of health care as a subject. In Health care yearbook av sjukskötarens arbete. I Epione, Jubileumsskrift 1898–
XI (pp. 9–21). Helsinki, Finland: Sairaanhoitajien 1988 (s. 28–38). Helsinki, Finland: SSY-sjuksköterske-
Koulutussäätiö.] föreningen i Finland r.f. [Future visions of the develop-
Eriksson, K. (1977). Hälsa—En teoretisk och begreppsana- ment of the nurse’s work. In Epione, Jubilee-script
lytisk studie om hälsa och dess nature. I Sairaanhoidon
vuosikirja XIV (s. 55–195). [Health—A conceptual
analysis and theoretical study of health and its nature.
In Health care yearbook XIV (pp. 155–195). Helsinki,
Finland: Sairaanhoitajien Koulutussäätiö.]
Eriksson, K. (1978). Modellen—Ett sätt att beskriva vårdskee-
ndet. I Sairaanhoidon vuosikirja XV (s. 189–225). Helsinki,

194 UNIT II  Nursing Philosophies between caring and spirituality (pp. 68–84). New York:
1898–1988 (pp. 28–38). Helsinki, Finland: SSY- Paulist Press.
sjuksköterske-föreningen i Finlandr.f.] Eriksson, K. (1997). Mot en vårdetisk teori. I Hoitotyön
vuosikirja 1997. Pro Nursing RY:n vuosikirja, Hygieia
Eriksson, K. (1991). Hälsa är mera än frånvaro av sjuk- (s. 9–23). Helsinki, Finland: Kirjayhtymä. [Toward an
dom. I Centrum för vårdvetenskap, Vård—Utbildning— ethical caring theory. In Nursing yearbook 1997. Pro
Utveckling—Forskning (s. 1–2, 29–35). Stockholm: Nursing RY:s yearbook, Hygieia (pp. 9–23). Helsinki,
Karolinska Institutet. [Health is more than the absence Finland: Kirjayhtymä.]
of illness. In Centrum för vårdvetenskap, Vård—Utbildning— Eriksson, K. (1997). Perustutkimus ja käsiteanalyysi.
Utveckling—Forskning (pp. 1–2, 29–35). Stockholm: I M. Paunonen & K. Vehviläinen-Julkunen (red.),
Karolinska Institute.] Hoitotieteen tutkimusmetodiikka (s. 50–75). Helsinki,
Finland: WSOY. [Basic research and conceptual anal-
Eriksson, K. (1992). Nursing: The caring practice “being ysis. In M. Paunonen & K. Vehviläinen-Julkunen
there.” In D. Gaut (Ed.), The practice of caring in nurs- (Eds.), The research methodology of caring science
ing (pp. 201–210). New York: National League for (pp. 50–75). Helsinki, Finland: WSOY.]
Nursing Press. Eriksson, K. (1998). Epione—Vårdandets ethos. I Epione,
Jubileumsskrift 1898–1998. Helsinki, Finland: SSY-
Eriksson, K. (1993). De första åren—Några reflektioner Sjuksköterskeföreningen. [Epione—The ethos of caring.
kring den vårdvetenskapliga eran. I Epione, Jubile- In Epione, Jubilee-script 1898–1998. Helsinki, Finland:
umsskrift 1898–1993 (s. 7–15). Helsinki, Finland: SSY-Sjuksköterskeföreningen.]
SSY-Sjuksköterskeföreningen. [The first years— Eriksson, K. (1998). Människans värdighet, lidande och
Reflections upon the era of caring science. In lidandets ethos. I Suomen Mielenterveysseura, Tuhkaa
Epione, Jubilee-script 1898–1993 (pp. 7–15). ja linnunrata. Henkisyys mielenterveystyössä (s. 67–82).
Helsinki, Finland: SSY-Sjuksköterskeföreningen.] Helsinki: Suomen Mielenterveysseura, SMS-julkaisut.
[Human dignity, suffering and the ethos of suffering. In
Eriksson, K. (1994). Theories of caring as health. In Ashes and the Milky Way: Spirituality in mental health
D. Gaut & A. Boykin (Eds.), Caring as healing: Renewal care nursing (pp. 67–82). Helsinki: Suomen Mielenter-
through hope (pp. 3–20). New York: National League veysseura, SMS-julkaisut.]
for Nursing Press. Eriksson, K. (1998). Understanding the world of the
patient, the suffering human being: The new clinical
Eriksson, K. (1994). Vårdvetenskapen som autonom disci- paradigm from nursing to caring. In C. E. Guzzetta
pline. I H. Willman (red.), Hygieia. Hoitotyön vuosikirja (Ed.), Essential readings in holistic nursing (pp. 3–9).
1994 (s. 87–91).). Helsinki, Finland: Kirjayhtymä. [Car- Gaithersburg, (MD): Aspen.
ing science as an autonomous discipline. In H. Will- Eriksson, K. (1999). Tillbaka till Popper och Kuhn—En evo-
man (Ed.), Hygieia. Nursing yearbook 1994 (pp. 87–91). lutionär epistemologi för vårdvetenskapen. I J. Kinnunen,
Helsinki, Finland: Kirjayhtymä.] P. Meriläinen, K. Vehviläinen-Julkunen, & T. Nyberg
(red.), Terveystieteiden monialainen tutkimus ja yliopistok-
Eriksson, K. (1996). Efterskrift—Om vårdvetenskapens oulutus. Suunnistuspoluilta tiedon valtatielle. Professor
möjligheter och gränser. I K. Martinsen (red.), Fenome- Sirkka Sinkkoselle omistettu juhlakirja (s. 21–35). Kuopio,
nologi og omsorg (s. 140–150). Oslo, Norway: TANO. Finland: Kuopion yliopiston julkaisuja E, Yhteiskuntati-
[Postscript—About the possibilities and boundaries of eteet 74. [Back to Popper and Kuhn—An evolutionary
caring science. In K. Martinsen (Ed.), Phenomenology epistemology for caring science. In J. Kinnunen,
and caring (pp. 140–150). Oslo, Norway: TANO.] P. Meriläinen, K. Vehviläinen-Julkunen, & T. Nyberg
(Eds.), The multiscientific health science university edu-
Eriksson, K. (1996). Om dokumentation—Vad den är och cation and research. Paths to the highway of science.
inte är. I K. Dahlberg (red.), Konsten att dokumentera A jubilee book dedicated to Professor Sirkka Sikkonen
omvårdnad (s. 9–13). Lund, Sweden: Studentlitteratur. (pp. 21–35). Kuopio, Finland: Kuopion yliopiston
[On documentation—What it is and what it is not. julkaisuja E, Yhteiskuntatieteet 74.]
In K. Dahlberg (Ed.), The art of documenting care Eriksson, K. (1999). Vårdvetenskapen—En akademisk
(pp. 9–13). Lund, Sweden: Studentlitteratur.] disciplin. I S. Janhonen, I. Lepola, M. Nikkonen, &
M. Toljamo (red.), Suomalainen hoitotiede uudelle
Eriksson, K. (1996). Om människans värdighet. I T. Bjer- vuosituhannelle. Professori Maija Hentisen juhlakirja
kreim, J. Mathinsen, & R. Nord (red.), Visjon, viten og
virke. Festskrift till sykepleieren Kjellaug Lerheim, 70 år
(s. 79–86). Oslo, Norway: Universitetsförlaget. [On hu-
man dignity. In T. Bjerkreim, J. Mathinsen, & R. Nord
(Eds.), Vision, knowledge and influence. Jubilee-script for
the nurse Kjellaug Lerheim, 70 years (pp. 79–86). Oslo,
Norway: Universitetsförlaget.]

Eriksson, K. (1997). Caring, spirituality and suffering. In
M. S. Roach (Ed.), Caring from the heart: The convergence

CHAPTER 11  Katie Eriksson 195

(s. 59–64). Oulu, Finland: Oulun yliopiston hoitoti- Transforming nursing through reflective practice. Oxford:
eteen ja terveyshallinnon laitoksen julkaisuja 2. [Car- Blackwell Science.
ing science—An academic discipline. In S. Janhonen, Eriksson, K., & Willman, H. (1972). Kohti parempaa
I. Lepola, M. Nikkonen, & M. Toljamo (Eds.), The ohjausta. I Sairaanhoidon vuosikirja IX (s. 131–139).
Finnish caring science in the new millennium. A jubilee- Helsinki, Finland: Sairaanhoitajien Koulutussäätiö.
script dedicated to Professor Maija Hentinen (pp. 59–64). [Toward a better counseling. In Health care yearbook IX
Oulu, Finland: Oulun yliopiston hoitotieteen ja (pp. 131–139). Helsinki, Finland: Sairaanhoitajien
terveyshallinnon laitoksen julkaisuja 2.] Koulutussäätiö.]
Eriksson, K. (2000). Caritas et passio—Liebe und leiden— Nielsen, G.B., Matilainen, D., & Eriksson, K. (2010). Caring
Als grundkategorien der pflegewissenschaft. I T. Strom, science, clinical supervision and discourse analysis – A
Diakonie an der Schwelle zum neuen Jahrtausend. route forward? Nordic College of Caring Sciences confer-
Heidelberg, Germany: Diakoniewissenschaftlichen In- ence 14–16.4.2010,Vasa, Finland. Abstract book pp. 28.
stituts, Universität Heidelberg. [Caritas et passio—Love Salmela, S., Eriksson, K., & Fagerström, L. (2011). A three
and suffering as basic categories in caring science. In dimensional model of leading innovation and change.
T. Strom, The diaconate on the threshold of the new International Nursing Management Conference 17–
millennium. Heidelberg, Germany: Diakoniewissen- 19.11.2011, Antalya, Turkey. Abstract book pp. 43–44.
schaftlichen Instituts, Universität Heidelberg.] Wikberg, A., Bondas, T., & Eriksson, K. (2010). Interpret-
Eriksson, K. (2002). Rakkaus—Diakoniatieteen ydin ja ing empirical studies by using meta ethnography. Nor-
ethos? I M. Lahtinen & T. Toikkanen (red.), Anno Do- dic College of Caring Sciences conference 14–16.4.2010,
mini. Diakoniatieteen vuosikirja 2002 (s. 155–164). Vasa, Finland. Abstract book pp. 26.
Tampere, Finland: Tammerpaino. [Love—The core and
ethos of deacony? In M. Lahtinen & T. Toikkanen Books and Monographs
(Eds.), Anno Domini. Diakonic yearbook 2002 Eriksson, K. (1974). Sjuksköterskeyrket—Hantverk eller
(pp. 155–164). Tampere, Finland: Tammerpaino.]
Eriksson, K. (2003). Diakonian erityisyys hoitotyössä. I M. profession? Sjuksköterskors samarbete i Norden. Rap-
Lahtinen & T. Toikkanen (red.), Anno domini. Diakoni- port från SSN: s expertgrupp för klargörande av vård-
atieteen vuosikirja 2003 (s. 120–126). Tampere, Finland: funktionsområdet. Helsinki, Finland: SSN. [The nurs-
Tammerpaino. [The uniqueness of deacony in nursing. ing profession—Skill or profession? Collaboration of
In M. Lahtinen & T. Toikkanen (Eds.), Anno Domini. nurses in the Nordic countries. Report from SSN’s
Diakonic yearbook 2003 (pp. 120–126). Tampere, expert group for the clarification of nursing. Helsinki,
Finland: Tammerpaino.] Finland: SSN.]
Eriksson, K. (2009). Evidens – Det sanna, det sköna, det Eriksson, K. (1975). Den teoretiska utgångspunkten för
goda och det eviga. I Martinsen, K., & Eriksson, K. Å vårdprocessen. Rapport från SSN: s symposium i Hels-
se og innse. Om ulike former for evidens (s. 35–80). Oslo, ingfors. Helsinki, Finland: SSN. [The theoretical start-
Norge, Akribe. [Evidence – The true, the beautiful, the ing point of the nursing care process. A report from
good and the eternal. In Martinsen, K., & Eriksson, K. SSN: s symposium in Helsinki. Helsinki, Finland: SSN.]
To see and to understand. About different forms of evi- Eriksson, K. (1976). Hoitotapahtuma. Hoito-oppi 2.
dence (pp. 35–80). Oslo, Norway, Akribe.] Helsinki, Finland: Sairaanhoitajien Koulutussäätiö.
Eriksson, K., & Hamrin, E. (1988). Vårdvetenskapen [The nursing care process. Nursing science 2. Helsinki,
formas—En tillbakablick och ett framtidsperspektiv. I Finland: Sairaanhoitajien Koulutussäätiö.]
Panakeia, vårdvetenskaplig årsbok (s. 9–16). Stockholm: Eriksson, K. (1976). Hälsa. En teoretisk och begreppsanalyt-
Almqvist & Wiksell. [Caring science is formed—A his- isk studie om hälsan och dess natur som mål för
torical and futuristic perspective. In Panakeia, caring hälsovårdsedukation. Licentiatavhandling, Helsinki,
science yearbook (pp. 9–16). Stockholm: Almqvist & Finland: Institutionen för pedagogik, Helsingfors uni-
Wiksell.] versitet. [Health. A conceptual analysis and theoretical
Eriksson, K., & Lindholm T. (2010). “Love Endures All study of health and its nature as a goal for health care
Things?” Violence Between Spouses, Suffering, and education. Unpublished licentiate thesis, Helsinki, Finland:
Alleviation of Suffering—Developing a Theory Model. Department of Education University of Helsinki.]
International Journal for Human Caring, 14(3), 72. Eriksson, K. (1979). Vårdprocessen. Stockholm: Almqvist
Eriksson, K., Nordman, T., & Kasén, A. (1998). Reflective & Wiksell. [The nursing care process. Stockholm:
practice: A way to the patient’s world and caring, the Almqvist & Wiksell.]
core of nursing. In C. Johns & D. Freshwater (Eds.), Eriksson, K. (1981). Vårdprocessen—En utgångspunkt för
läroplanstänkande inom vårdutbildningen. Utvecklande

196 UNIT II  Nursing Philosophies Eriksson, K. (1989). Hälsans idé. (2:a uppl.). Stockholm:
av en vårdprocessmodell samt ett läroplanstänkande ut- Almqvist & Wiksell. [The idea of health (2nd ed.).
gående från vårdprocessen (Nr. 94). Helsinki, Finland: Stockholm: Almqvist & Wiksell.]
Helsingfors universitet, Pedagogiska Institutionen. [The
nursing care process—An approach to curriculum con- Eriksson, K. (1989). Terveyden idea. Helsinki, Finland:
struction within nursing education. The development of a Sairaanhoitajien Koulutussäätiö. [The idea of health.
model for the nursing care process and an approach for Helsinki, Finland: Sairaanhoitajien Koulutussäätiö.]
curriculum development based on the process of nursing
care (No. 94). Helsinki, Finland: Department of Educa- Eriksson, K. (1992). Broar. Introduktion i vårdvetenskaplig
tion University of Helsinki.] metod. Vaasa, Finland: Institutionen för vårdvetenskap,
Åbo Akademi. [Bridges. Introduction to the methods of
Eriksson, K. (1982). Vårdprocessen (2:a uppl.). Stockholm: caring science. Vaasa, Finland: Department of Caring
Almqvist & Wiksell. [The nursing care process (2nd ed.). Science, Åbo Akademi.]
Stockholm: Almqvist & Wiksell.]
Eriksson, K. (1994). Den lidande människan. Stockholm:
Eriksson, K. (1983). Introduktion till vårdvetenskap. Stock- Liber Förlag. [The suffering human being. Stockholm:
holm: Almqvist & Wiksell. [An introduction to caring Liber Förlag.]
science. Stockholm: Almqvist & Wiksell.]
Eriksson, K. (1995). Det lidende menneske (Danish trans-
Eriksson, K. (1984). Hälsans idé. Stockholm: Almqvist lation). Copenhagen: Munksgaard. [The suffering
& Wiksell. [The idea of health. Stockholm: Almqvist human being (Danish translation). Copenhagen:
& Wiksell.] Munksgaard.]

Eriksson, K. (1985). Johdatus hoitotieteeseen. Helsinki, Eriksson, K. (1995). Den lidende menneske (Norwegian
Finland: Sairaanhoitajien Koulutussäätiö. [An introduc- translation). Oslo: TANO. [The suffering human being
tion to caring science. Helsinki, Finland: Sairaanhoitajien (Norwegian translation). Oslo: TANO.]
Koulutussäätiö.]
Eriksson, K. (1996). Omsorgens idé (Danish translation).
Eriksson, K. (1985). Vårddidaktik. Stockholm: Almqvist Copenhagen: Munksgaard. [The idea of caring (Danish
& Wiksell. [Caring didactics. Stockholm: Almqvist & translation). Copenhagen: Munksgaard.]
Wiksell.]
Eriksson, K. (1997). Vårdandets idé (Kassettband). Talboksoch
Eriksson, K. (1985). Vårdprocessen (3: e uppl.). Stockholm: punktskriftsbiblioteket. Stockholm: Almqvist & Wiksell.
Almqvist & Wiksell. [The nursing care process (3rd ed.). [The idea of caring (Audiotape). Talboksoch
Stockholm: Almqvist & Wiksell.] punktskriftsbiblioteket. Stockholm: Almqvist & Wiksell.]

Eriksson, K. (1986). Hoito-opin didaktiikka. Helsinki, Eriksson, K. (2001). Gesundheit. Ein Schlüsselbegriff der
Finland: Sairaanhoitajien Koulutussäätiö. [The didac- Pflegetheorie. (German translation). Bern, Germany:
tics of caring science. Helsinki, Finland: Sairaanhoitajien Verlag Hans Huber. [The idea of health (German
Koulutussäätiö.] translation). Bern, Germany: Verlag Hans Huber.]

Eriksson, K. (1986). Introduktion till vårdvetenskap (2: Eriksson, K. (2006). The suffering human being. Chicago:
a uppl.). Stockholm: Almqvist & Wiksell. [An introduc- Nordic Studies Press. [English translation of: Den lidande
tion to caring science (2nd ed.). Stockholm: Almqvist människan. Stockholm, Sweden: Liber Förlag.1994.]
& Wiksell.]
Eriksson, K., & Barbosa da Silva, A. (Eds.). (1994). Usko ja
Eriksson, K. (1987). Hoitamisen idea. Forssa, Finland: terveys—johdatus hoitoteologiaan.(Finnish translation).
Sairaanhoitajien Koulutussäätiö. [The idea of caring. Helsinki, Finland: Sairaanhoitajien Koulutussäätiö.
Forssa, Finland: Sairaanhoitajien Koulutussäätiö.] [Caring theology (Finnish translation). Helsinki,
Finland: Sairaanhoitajien Koulutussäätiö.]
Eriksson, K. (1987). Pausen. En beskrivning av vårdvetens-
kapens kunskapsobjekt. Stockholm: Almqvist & Wiksell. Eriksson, K., Byfält, H., Leijonqvist, G-B., Nyberg, K., &
[The pause. A description of the knowledge object of car- Uuspää, B. (1986). Vårdteknologi. Stockholm: Almqvist
ing science. Stockholm: Almqvist & Wiksell.] & Wiksell. [Caring technology. Stockholm: Almqvist &
Wiksell.]
Eriksson, K. (1987). Vårdandets idé. Stockholm: Almqvist
& Wiksell. [The idea of caring.Stockholm: Almqvist & University and Department Publications
Wiksell.] Eriksson, K. (1988). Vårdvetenskap som disciplin, forsknings-

Eriksson, K. (1988). Hoito tieteenä. Forssa, Sweden: och tillämpningsområde. Vårdforskningar 1/1988. Vaasa,
Sairaanhoitajien Koulutussäätiö. [Caring as a science. Finland: Institutionen för vårdvetenskap, Åbo Akademi.
Forssa, Sweden: Sairaanhoitajien Koulutussäätiö.] [Caring science as a discipline, field of research and applica-
tion. Vaasa, Finland: Department of Caring Science,
Eriksson, K. (1989). Caritas-idea. Helsinki, Finland: Åbo Akademi.]
Sairaanhoitajien Koulutussäätiö. [The idea of caritas.
Helsinki, Finland: Sairaanhoitajien Koulutussäätiö.]

Eriksson, K. (1990). Pro Caritate. En lägesbestämning av CHAPTER 11  Katie Eriksson 197
caritativ vård. Vårdforskningar 2/1990. Vaasa, Finland: G. Grahn (red.), Leva med demenshandikapp. Lund,
Institutionen för vårdvetenskap, Åbo Akademi. [Pro Sweden: Lunds universitet: Stiftelsen Silviahemmet.
Caritate. Caritative caring—A positional analysis. Vaasa, [Becoming ill with dementia—A burdensome suffering
Finland: Department of Caring Science, ÅboAkademi.] for the patient and his/her family. In B. Beck-Friis &
G. Grahn (Eds.), Living with the handicap of dementia
Eriksson, K. (1991). Att lindra lidande. I K. Eriksson & (Action in favor of people suffering from neurodegenera-
A. Barbosa da Silva (red.), Vårdteologi. Vårdforskningar tive diseases). Lund, Sweden: Lunds universitet,
3/1991 (s. 204–221). Vaasa, Finland: Institutionen för Stiftelsen Silviahemmet.]
vårdvetenskap, Åbo Akademi. [To alleviate suffering. Eriksson, K. (1998). Vårdvetenskapens framväxt som aka-
In K. Eriksson & A. Barbosa da Silva (Eds.), Caring demisk disciplin—Ett finlandssvenskt perspektiv.
theology (pp. 204–221). Vaasa, Finland: Department I K. Eriksson (red.), Jubileumsskrift 1987–1997 (s. 1–7).
of Caring Science, Åbo Akademi.] Vaasa, Finland: Institutionen för vårdvetenskap, Åbo
Akademi. [The growth of caring science as an academic
Eriksson, K. (1991). Vårdteologins framväxt. I K. Eriksson discipline—A Finland-Swedish perspective. In K. Eriksson
& A. Barbosa da Silva (red.), Vårdteologi. Vårdforsknin- (Ed.), Jubilee-script 1987–1997 (pp. 1–7). Vaasa, Finland:
gar 3/1991 (s. 1–25). [The growth of caring theology. In Department of Caring Science, Åbo Akademi.]
K. Eriksson & A. Barbosa da Silva (Eds.), Caring theol- Eriksson, K. (2001). Vårdvetenskap som akademisk discip-
ogy (pp. 1–25). Vaasa, Finland: Department of Caring lin. Vårdforskning 7/2001. Vaasa, Finland: Institutionen
Science, Åbo Akademi.] för vårdvetenskap, Åbo Akademi. [Caring science as an
academic discipline. Caring research 7/2001. Vaasa,
Eriksson, K. (1993). Lidandets idé. I K. Eriksson (red.), Finland: Department of Caring Science, Åbo Akademi.]
Möten med lidanden. Vårdforskningar 4/1993 (s. 1–27). Eriksson, K. (2002). Den trojanske hest. Evidensbasering og
Vaasa, Finland: Institutionen för vårdvetenskap, Åbo sygepleje. (Danish translation). Copenhagen: Gads
Akademi. [The idea of suffering. In K. Eriksson (Ed.), Förlag. [The Trojan horse. Evidence-based nursing and
Encounters with suffering (pp. 1–27). Vaasa, Finland: caring through a caring science perspective (Danish
Department of Caring Science, Åbo Akademi.] translation). Copenhagen: Gads Förlag.]
Eriksson, K. (2002). Idéhistoria som deldisciplin inom
Eriksson, K. (red.). (1993). Möten med lidanden.Vårdfor- vårdvetenskapen. I K. Eriksson & D. Matilainen (red.),
skning 4/1993. Vaasa, Finland: Institutionen för vård- Vårdandets och vårdvetenskapens idéhistoria. Strövtåg i
vetenskap, Åbo Akademi. [Encounters with suffering. spårandet av “caritas originalis.” Vårdforskning 8/2002
Vaasa, Finland: Department of Caring Science, (s. 1–14). Vaasa, Finland: Institutionen för vårdvetenskap,
Åbo Akademi.] Åbo Akademi. [The history of ideas as a sub-discipline
within caring science. In K. Eriksson & D. Matilainen
Eriksson, K. (red.). (1995). Den mångdimensionella (Eds.), The history of ideas of caring and caring science.
hälsan—Verklighet och visioner. Slutrapport. Vaasa, Wanderings in search of “caritas originalis.” Caring
Finland: Vasa sjukvårdsdistrikt kf. och Institutionen research 8/2002 (pp. 1–14). Vaasa, Finland: Department
för vårdvetenskap, Åbo Akademi. [Multidimensional of Caring Science, Åbo Akademi.]
health—Visions and reality. Final report. Vaasa, Finland: Eriksson, K. (2002). Vårdandets idéhistoria. I K. Eriksson &
Vasa sjukvårdsdistrikt kf. och Institutionen för D. Matilainen (red.), Vårdandets och vårdvetenskapens
vårdvetenskap, Åbo Akademi.] idéhistoria. Strövtåg i spårandet av “caritas originalis.”
Vårdforskning 8/2002 (s. 15–34). Vaasa, Finland: Insti-
Eriksson, K. (1995). Mot en caritativ vårdetik. I K. Eriksson tutionen för vårdvetenskap, Åbo Akademi. [The history
(red.), Mot en caritativ vårdetik. Vårdforskning 5/1995 of ideas of caring. In K. Eriksson & D. Matilainen
(s. 9–40). Vaasa, Finland: Institutionen för vårdvetens- (Eds.), The history of ideas of caring and caring science.
kap, Åbo Akademi. [Toward a caritative caring ethic. Wanderings in search of “caritas originalis.” Caring
In K. Eriksson (Ed.), Toward a caritative caring ethic. research 8/2002 (pp. 15–34). Vaasa, Finland: Depart-
Caring research 5/1995. (pp. 9–40). Vaasa, Finland: ment of Caring Science, Åbo Akademi.]
Department of Caring Science, Åbo Akademi.] Eriksson, K. (2003). Ethos. I K. Eriksson & U. Å. Lindström
(red.), Gryning II. Klinisk vårdvetenskap (s. 21–34).
Eriksson, K. (1995). Vad är vårdetik? I K. Eriksson (red.), Vaasa, Finland: Institutionen för vårdvetenskap, Åbo
Mot en caritativ vårdetik. Vårdforskning 5/1995 Akademi. [Ethos. In K. Eriksson & U. Å. Lindström
(s. 1–8). Vaasa, Finland: Institutionen för vårdvetenskap, (Eds.), Dawn II. Clinical caring science (pp. 21–34).
Åbo Akademi. [What is caring ethic? In K. Eriksson
(Ed.), Toward a caritative caring ethic (pp. 1–8). Vaasa,
Finland: Department of Caring Science, Åbo Akademi.].
Caring research 5/1995.

Eriksson, K. (1997). Att insjukna i demens—Ett tungt
lidande för patient och anhöriga. I B. Beck-Friis &

198 UNIT II  Nursing Philosophies caring science research. In K. Eriksson (Ed.), Encounters
Vaasa, Finland: Department of Caring Science, with suffering. Caring research 4/1993 (pp. 55–78).
Åbo Akademi.] Vaasa, Finland: Department of Caring Science,
Åbo Akademi.]
Eriksson, K., & Barbosa da Silva, A. (1991). Vårdteologi Eriksson, K., & Koort, P. (1973). Sjukvårdspedagogik
som vårdvetenskapens deldisciplin. I K. Eriksson & (Kompendium). Helsinki, Finland: Helsingfors svenska
A. Barbosa da Silva (red.), Vårdteologi. Vårdforskningar sjukvårdsinstitut. [The pedagogy of nursing care
3/1991 (s. 26–64). Vaasa, Finland: Institutionen för (Compendium). Helsinki, Finland: Helsingfors svenska
vårdvetenskap, Åbo Akademi. [Caring theology as a sjukvårdsinstitut.]
sub-discipline of caring science. In K. Eriksson & Eriksson, K., & Lindholm, L. (1993). Lidande och kärlek ur
A. Barbosa da Silva (Eds.), Caring theology. Caring ett psykiatriskt vårdperspektiv—En casestudie av mötet
research 3/1991 (pp. 26–64). Vaasa, Finland: mellan mänskligt lidande och kärlek. I K. Eriksson
Department of Caring Science, Åbo Akademi.] (red.), Möten med lidanden. Vårdforskningar 4/1993 suf-
fering (s. 79–137). Vaasa, Finland: Institutionen för
Eriksson, K., Bondas-Salonen, T., Fagerström, L., Herberts, S., vårdvetenskap, Åbo Akademi. [Love and suffering
& Lindholm, L. (red.). (1990). Den mångdimensionella through a psychiatric caring perspective—A case study
hälsan. En pilotstudie över uppfattningar bland patien- of the encounters with human love and suffering. In
ter, skolungdomar och lärare (Projektrapport 1). Vaasa, K. Eriksson (Ed.), Encounters with suffering. Caring
Finland: Vasa sjukvårdsdistrikt kf. och Institutionen research 4/1993 (pp. 79–137). Vaasa, Finland: Depart-
för vårdvetenskap, Åbo Akademi. [Multidimensional ment of Caring Science, Åbo Akademi.]
health. A pilot study of understanding health among pa- Eriksson, K., & Lindström, U. Å. (2000). Gryning. En vård-
tients, students and teachers (Project Rep. 1). Vaasa, vetenskaplig antologi. Vaasa, Finland: Institutionen för
Finland: Vasa sjukvårdsdistrikt kf. och Institutionen vårdvetenskap, Åbo Akademi. [Dawn. An anthology of
för vårdvetenskap, Åbo Akademi.] caring science. Vaasa, Finland: Department of Caring
Science, Åbo Akademi.]
Eriksson, K., & Herberts, S. (1991). Tron i hälsans tjänst. Eriksson, K., & Lindström, U. Å. (2000). Siktet, Sökandet, slu-
I K. Eriksson & A. Barbosa da Silva (red.), Vårdteologi. tandet. I K. Eriksson & U. Å. Lindstöm (red.), Gryning. En
Vårdforskningar 3/1991 (s. 222–258). Vaasa Finland: vårdvetenskaplig antologi (s. 5–18). Vaasa, Finland:
Institutionen för vårdvetenskap, Åbo Akademi. [Faith Institutionen för vårdvetenskap, Åbo Akademi. [Envision-
in the service of health. In K. Eriksson & A. Barbosa da ing, seeking and ending. In K. Eriksson & U. Å. Lind-
Silva (Eds.), Caring theology. Caring research 3/1991 ström (eds.), Dawn. An anthology of caring science (pp.
(pp. 222–258). Vaasa Finland: Department of Caring 5–18). Vaasa, Finland: Department of Caring Science,
Science, Åbo Akademi. Åbo Akademi.]
Eriksson, K., & Lindström, U. Å. (2003). Klinisk vård-
Eriksson, K., & Herberts, S. (1992). Den mångdimensio- vetenskap. I K. Eriksson & U. Å. Lindström (red.),
nella hälsan. En studie av hälsobilden hos sjukvårdsle- Gryning II. Klinisk vårdvetenskap (s. 3–20). Vaasa,
dare och sjukvårdspersonal (Projektrapport 2). Vaasa, Finland: Institutionen för vårdvetenskap, Åbo Aka-
Finland: Vasa sjukvårdsdistrikt kf och Institutionen för demi. [Clinical caring science. In K. Eriksson & U. Å.
vårdvetenskap, Åbo Akademi. [Multidimensional Lindström (Eds.), Dawn II. Clinical caring science
health. A study of the views of health among health care (pp. 3–20). Vaasa, Finland: Department of Caring
leaders and health care personnel (Project Rep. 2). Science, Åbo Akademi.
Vaasa, Finland: Vasa sjukvårdsdistrikt kf och Institu- Eriksson, K., & Lindström, U. Å. (2007). Vårdvetenskapens
tionen för vårdvetenskap, Åbo Akademi.] vetenskapsteori på hermeneutisk grund—några grund-
drag. I K. Eriksson, U. Å. Lindström, D. Matilainen &
Eriksson, K., & Herberts, S. (1993). Lidande—En begrepps- L. Lindholm (red.), Gryning III. Vårdvetenskap och
analytisk studie. I K. Eriksson (red.), Möten med lidan- hermeneutik (s. 5–20). Vaasa, Finland: Enheten för
den. Vårdforskningar 4/1993 (s. 29–54). Vaasa, Finland: vårdvetenskap, Åbo Akademi. [The theory of science
Institutionen för vårdvetenskap, Åbo Akademi. [A study for caring science on a hermeneutic foundation—some
of suffering—A concept analysis. In K. Eriksson (Ed.), basic features. In K. Eriksson, U. Å. Lindström, D.
Encounters with suffering. Caring research 4/1993 Matilainen & L. Lindholm (Eds.), Dawn III. Caring
(pp. 29–54). Vaasa, Finland: Department of Caring science and hermeneutics (pp. 5–20). Vaasa, Finland:
Science, Åbo Akademi.] Department of Caring Science, Åbo Akademi.]

Eriksson, K., Herberts, S., & Lindholm, L. (1993). Bilder
av lidande—Lidande i belysning av aktuell vårdvetens-
kaplig forskning. I K. Eriksson (red.), Möten med lidan-
den. Vårdforskningar 4/1993 suffering (s. 55–78). Vaasa,
Finland: Institutionen för vårdvetenskap, Åbo Akademi.
[Views of suffering—Suffering in the light of current

Eriksson, K., & Matilainen, D. (red.). (2002). Vårdandets CHAPTER 11  Katie Eriksson 199
och vårdvetenskapens idéhistoria. Strövtåg i spårandet Doctoral dissertation, Turku, Finland, Åbo Akademi
av “caritas originalis”. Vårdforskning 8/2002. Vaasa, University Press.]
Finland: Institutionen för vårdvetenskap, Åbo Akademi. Bondas, T. (2000). Att vara med barn: en vårdvetenskaplig
[Eriksson, K., & Matilainen, D. (eds.). The history of studie av kvinnors upplevelser under perinatal tid.
ideas of caring and caring science. Wanderings in search Doktorsavhandling, Turku, Finland, Åbo Akademis
of “caritas originalis.” Caring research 8/2002. Vaasa, Förlag. [To be with child: a study of women’s lived
Finland: Department of Caring Science, Åbo Akademi.] experiences during the perinatal period from a caring
science perspective. Doctoral dissertation, Turku,
Eriksson, K., & Matilainen, D. (red.). (2004). Vårdvetens- Finland, Åbo Akademi University Press.]
kapens didaktik. Caritativ didaktik i vårdandets tjänst. Caspari, S. (2004). Det gyldne snitt. Den estetiske dimensjon,
Vårdforskningar 9/2004. Vaasa, Finland: Institutionen en kilde til helse og et etisk anliggende. Doktorsavhan-
för vårdvetenskap, Åbo Akademi. [The didactics of dling, Turku, Finland, Åbo Akademis Förlag. [The golden
caring science. Caritative didactics in the service of section. The aestethic dimension—a source of health.
caring. Vaasa, Finland: Department of Caring Science, Doctoral dissertation, Turku, Finland, Åbo Akademi
Åbo Akademi.] University Press.]
Edlund, M. (2002). Människans värdighet-ett grundbegrepp
Eriksson, K., & Nordman, T. (2004). Den trojanska hästen inom vårdvetenskapen. Doktorsavhandling, Turku,
II—Utvecklande av evidensbaserade vårdande kulturer. Finland, Åbo Akademis Förlag. [Human dignity—A
Vaasa, Finland: Institutionen för vårdvetenskap, basic caring science concept. Doctoral dissertation,
Åbo Akademi. [The Trojan horse II—Development Turku, Finland, Åbo Akademi University Press.]
of evidence-based caring cultures. Vaasa, Finland: Ekebergh, M. (2001). Tillägnandet av vårdvetenskaplig
Department of Caring Science, Åbo Akademi.] kunskap. Reflexionens betydelse för lärandet. Doktor-
savhandling, Turku, Finland, Åbo Akademis Förlag.
Eriksson K., Nordman T., & Myllymäki I. (1999). Den tro- [Acquiring caring science knowledge—The importance
janska hästen. Evidensbaserat vårdande och vårdarbete of reflection for learning. Doctoral dissertation, Turku,
ur ett vårdvetenskapligt perspektiv cultures (Rap. 1). Finland, Åbo Akademi University Press.]
Vaasa, Finland: Institutionen för vårdvetenskap, Fagerström, L. (1999). The patient’s caring needs. To un-
Åbo Akademi; Helsingfors universitetscentralsjukhus derstand and to measure the unmeasurable. Doctoral
& Vasa sjukvårdsdistrikt. [The Trojan horse II— dissertation, Turku, Finland, Åbo Akademi University
Development of evidence-based caring cultures (Rep. 1). Press.
Vaasa, Finland: Institutionen för vårdvetenskap, Foss, B. (2012). Ledelse—en bevegelse i ansvar og kjær-
Åbo Akademi; Helsingfors universitetscentralsjukhus lighet. Doktorsavhandling, Turku, Finland, Åbo Akade-
& Vasa sjukvårdsdistrikt. mis förlag. [Leadership—A movement in responsibility
and love. Doctoral dissertation, Turku, Finland, Åbo
Herberts, S., & Eriksson, K. (1995). Vårdarnas etiska profil. Akademi University Press.]
I K. Eriksson (red.), Mot en caritativ vårdetik. Vårdfor- Fredriksson, L. (2003). Det vårdande samtalet. Doktor-
skning 5/1995 (s. 41–62). Vaasa, Finland: Institutionen savhandling, Turku, Finland, Åbo Akademis Förlag.
för vårdvetenskap, Åbo Akademi. [The ethical profile [The caring conversation. Doctoral dissertation, Turku,
of the carers. In K. Eriksson (Ed.), Toward a caritative Finland, Åbo Akademi University Press.
caring ethic. Caring research 5/1995 (pp. 41–62). Vaasa, Gustafsson, L-K. (2008). Försoning ur ett vårdvetenskap-
Finland: Department of Caring Science, Åbo Akademi.] ligt perspektiv. Doktorsavhandling, Turku, Finland,
Åbo Akademis förlag. [Reconciliation—From a caring
Secondary Sources perspective. Doctoral dissertation, Turku, Finland,
Doctoral Dissertations Åbo Akademi University Press.]
Andersson, M. (1994). Integritet som begrepp och prin- Helin, K. (2011). Den vårdande och helande bilden—
möten med bildkonst i vårdandets värld. Doktor-
cip. En studie av ett vårdetiskt ideal i utveckling. Dok- savhandling, Turku, Finland, Åbo Akademis förlag.
torsavhandling, Turku, Finland, Åbo Akademis Förlag. [The caring and healing image—Encountering works of
[Integrity as a concept and as a principle in health care visual art in the caring context. Doctoral dissertation,
ethics. Doctoral dissertation, Turku, Finland, Åbo Turku, Finland, Åbo Akademi University Press.]
Akademi University Press.] Hilli, Y. (2007). Hemmet som ethos. En idéhistorisk studie
Arman, M. (2003). Lidande och existens i patientens av hur hemmet som ethos blev evident i hälsosysterns
värld. Kvinnors upplevelser av att leva med bröstcan-
cer. Doktorsavhandling, Turku, Finland, Åbo Akademis
Förlag. [Suffering and existence in the patient’s world.
Women’s experiences of living with breast cancer.

200 UNIT II  Nursing Philosophies Doctoral dissertation, Turku, Finland, Åbo Akademi
vårdande under 1900-talets första hälft. Doktorsavhan- University Press.]
dling, Turku, Finland, Åbo Akademis Förlag. [The Lindström, U. Å. (1992). De psykiatriska specialsjuk-
home as ethos. A history of ideas study of how the skötarnas yrkesparadigm. Doktorsavhandling, Turku,
home as ethos became evident in public health nurses’ Finland, Åbo Akademis Förlag. [The professional
caring during the first half of the 20th century. paradigm of the qualified psychiatric nurses. Doc-
Doctoral dissertation, Turku, Finland, Åbo Akademi toral dissertation, Turku, Finland, Åbo Akademi
University Press.] University Press.]
Lindwall, L. (2004). Kroppen som bärare av hälsa och lidande.
Karterud, D. (2006). Den etiske akten—Den caritative Doktorsavhandling, Turku, Finland, Åbo Akademis Förlag.
etikken når pasientens fordringer er av eksistensiell art. [The body as a carrier of health and suffering. Doctoral
Doktorsavhandling, Turku, Finland, Åbo Akademis dissertation, Turku, Finland, Åbo Akademi University
Förlag. [The ethical act—caring ethics when the pa- Press.]
tients’ demands are existential. Doctoral dissertation, Matilainen, D. (1997). Idémönster i Karin Neuman-Rahns
Turku, Finland, Åbo Akademi University Press.] livsgärning och författarskap—En idéhistorisk-biografisk
studie i psykiatrisk vård i Finland under 1900-talets
Kasén, A. (2002). Den vårdande relationen. Doktorsavhan- första hälft. Doktorsavhandling, Turku, Finland, Åbo
dling, Turku, Finland, Åbo Akademis Förlag. [The car- Akademis Förlag. [Patterns of ideas in Karin Neuman-
ing relationship. Doctoral dissertation, Turku, Finland, Rahns’ life-work and writings—A study of psychiatric
Åbo Akademi University Press.] care in Finland in the former part of the twentieth
century, based on biography and the history of ideas.
Koskinen, C. (2011). Lyssnande—en vårdvetenskaplig Doctoral dissertation, Turku, Finland, Åbo Akademi
betraktelse. Doktorsavhandlin, Turku, Finland, Åbo University Press.]
Akademis förlag. [Listening—A caring science reflec- Nilsson, B. (2004). Savnets tone i ensomhetens melodi.
tion. Doctoral dissertation, Turku, Finland, Åbo Ensomhet hos aleneboende personer med alvorlig
Akademi University Press.] psykisk lidelse. Doktorsavhandling, Turku, Finland,
Åbo Akademis Förlag. [The tune of want in the loneli-
Koslander, T. (2011). Ljusets gemenskap—en gestaltning ness melody. Doctoral dissertation, Turku, Finland,
av den andliga dimensionen i vårdandet. Doktor- Åbo Akademi University Press.]
savhandling, Turku, Finland, Åbo Akademis förlag. Nordman, T. (2006). Människan som patient i en vårdande
[The Communion of the Light—Shaping of spiritual kultur. Doktorsavhandling, Vaasa, Finland: Enheten för
dimension in the caritative caring. Doctoral disserta- vårdvetenskap, Åbo Akademi. [A human being as a pa-
tion, Turku, Finland, Åbo Akademi University Press.] tient in a caring culture. Doctoral dissertation, Vaasa,
Finland: Department of Caring Science, Åbo Akademi
Kärkkäinen, O. (2005). Documentation of Patient Care as University.]
Evidence of Caring Substance. Doctoral dissertation, Nurminen, M. (2009). Tid och det tidlösa i tiden. En
Vaasa, Finland: Department of Caring Science, Åbo frambrytande vårdvetenskaplig teorigestaltning. Dok-
Akademi University. torsavhandlin, Turku, Finland, Åbo Akademis förlag.
[Time and the timeless within time—An emerging
Lassenius, E. (2005). Rummet i vårdandets värld. Doktor- foundation for the theory of caring science. Doctoral
savhandling, Turku, Finland, Åbo Akademis Förlag. dissertation, Turku, Finland, Åbo Akademi University
[The space in the world of caring. Doctoral disserta- Press.]
tion, Turku, Finland, Åbo Akademi University Press.] Nyback, M-H. (2008). Generic and professional caring in
a Chinese setting—an ethnographic study. Doctoral
Levy-Malmberg, R. (2010). Interpretive dialogical evalua- dissertation, Turku, Finland, Åbo Akademi University
tion. Evaluating caring science basic research. Doctoral Press.
dissertation, Turku, Finland, Åbo Akademi University Nåden, D. (1998). När sykepleie er kunstutøvelse. En un-
Press. dersøkelse av noen nødvendige forutsetninger for syke-
pleie som kunst. Doktorsavhandling, Vaasa, Finland:
Lindholm, L. (1998). Den unga människans hälsa och Institutionen för vårdvetenskap, Åbo Akademi. [When
lidande. Doktorsavhandling, Vaasa, Finland: Institu- caring is an exercise of art. An examination of some
tionen för vårdvetenskap, Åbo Akademi. [The young necessary preconditions of nursing as an art. Doctoral
person’s health and suffering. Doctoral dissertation, Vaasa,
Finland: Department of Caring Science, Åbo Akademi
University.]

Lindholm, T. (2008). Kaikki se kärsii? Parisuhdeväki-
valta, kärsimys ja sen lievittäminen naisten ja miesten
näkökulmasta. Doktorsavhandling, Turku, Finland,
Åbo Akademis förlag. [Love endures all things? Vio-
lence between spouses, suffering and alleviation of
suffering from the viewpoint of women and men.

dissertation, Vaasa, Finland: Department of Caring CHAPTER 11  Katie Eriksson 201
Science, Åbo Akademi University.] Råholm, M-B. (2003). I kampens och modets dialektik.
Näsman, Y. (2010). Hjärtats vanor, tankens välvilja och
handens gärning—dygd som vårdetiskt grundbegrepp. Doktorsavhandling, Turku, Finland, Åbo Akademis
Doktorsavhandling, Turku, Finland, Åbo Akademis Förlag. [In the dialectic of struggle and courage.
förlag. [Habits of the heart, benevolence of the mind, Doctoral dissertation, Turku, Finland, Åbo Akademi
and deeds of the hand—Virtue as a basic concept in University Press.]
caring ethics. Doctoral dissertation, Turku, Finland, Sæteren, B. (2006). Kampen for livet i vemodets slør. Å
Åbo Akademi University Press.] leve i spenningsfeltet mellom livets mulighet og dødens
Rehnsfeldt, A. (1999). Mötet med patienten i ett livsavgörande nødvendighet. Doktorsavhandling, Turku, Finland,
skede. Doktorsavhandling, Turku, Finland, Åbo Akademi. Åbo Akademis Förlag. [Struggling for life in the veil of
[The encounter with the patient in a life-changing process. pensiveness. A life between the pressure created by the
Doctoral dissertation, Turku, Finland, Åbo Akademi possibility of life and the necessity of death. Doctoral
University Press.] dissertation, Turku, Finland, Åbo Akademi University
Rosengren, A-L. (2009). Hälsans grund kan bara hjärtat Press.]
förstå. Ett sökande efter kunskap om hälsa i ljuset av Sivonen, K. (2000). Vården och det andliga. En bestämning
Blaise Pascals tänkande. Doktorsavhandling, Turku, av begreppet ‘andlig’ ur ett vårdvetenskapligt perspektiv.
Finland, Åbo Akademis förlag. [The foundation of Doktorsavhandling, Turku, Finland, Åbo Akademis
health can be understood by the heart only—In pursuit Förlag. [Features of spirituality in caring. Doctoral
of knowledge about health in the light of Blaise Pascal’s dissertation, Turku, Finland, Åbo Akademi University
thinking. Doctoral dissertation, Turku, Finland, Åbo Press.]
Akademi University Press.] Söderlund, M. (2004). Som drabbad av en orkan. Anhöri-
Roxberg, Å. (2005). Vårdande och icke-vårdande tröst. gas tillvaro när en närstående drabbas av demens.
Doktorsavhandling, Turku, Finland: Åbo Akademis Doktorsavhandling, Turku, Finland, Åbo Akademis
Förlag. [Caring and non-caring consolation. Doctoral Förlag. [As if struck by a hurricane: The situation of
dissertation, Turku, Finland, Åbo Akademi University the relatives of someone suffering from dementia.
Press.] Doctoral dissertation, Turku, Finland, Åbo Akademi
Rudolfsson, G. (2007). Den perioperativa dialogen—en University Press.]
gemensam värld. Doktorsavhandling, Vaasa, Finland: von Post, I. (1999). Professionell naturlig vård ur anestesoch
Enheten för vårdvetenskap, Åbo Akademi. [The periop- operationssjuksköterskors perspektiv. Doktorsavhandling,
erative dialogue—a common world. Doctoral disserta- Turku, Finland, Åbo Akademis Förlag. [Professional nat-
tion, Vaasa, Finland: Department of Caring Science, ural care from the perspective of nurse anesthetists and
Åbo Akademi University.] operating room nurses. Doctoral dissertation, Turku,
Rundqvist, E. (2004). Makt som fullmakt. Ett vårdvetens- Finland, Åbo Akademi University Press.]
kapligt perspektiv. Doktorsavhandling, Turku, Finland, Wallinvirta, E. (2011). Ansvar som klangbotten i vårdan-
Åbo Akademis Förlag. [Power as authority. A caring dets meningssammanhang. Doktorsavhandling, Turku,
science perspective. Doctoral dissertation, Turku, Finland, Åbo Akademis förlag. [Responsibility as
Finland, Åbo Akademi University Press.] sounding board in the caring’s context of meaning.
Rydenlund, K. (2012). Vårdandets imperativ i de yttersta Doctoral dissertation, Turku, Finland, Åbo Akademi
livsrummen. Hermeneutiska vårdande samtal inom University Press.]
den rättspsykiatriska vården. Doktorsavhandling, Wiklund, L. (2000). Lidandet som kamp och drama. Doktor-
Turku, Finland, Åbo Akademis förlag. [The imperative savhandling, Turku, Finland, Åbo Akademis Förlag.
of caring in extreme living-spaces—Hermeneutical car- [Suffering as struggle and as drama. Doctoral dissertation,
ing conversations in forensic psychiatric care. Doctoral Turku, Finland, Åbo Akademi University Press.]
dissertation, Turku, Finland, Åbo Akademi University Wärnå, C. (2002). Dygd och hälsa. Doktorsavhandling,
Press.] Turku, Finland, Åbo Akademis Förlag. [Virtue and
health. Doctoral dissertation, Turku, Finland, Åbo
Akademi University Press.]

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IIIUNIT

Nursing Conceptual Models

n Nursing conceptual models are concepts and their relationships that specify a
perspective and produce evidence among phenomena specific to the discipline.

n Conceptual models address broad metaparadigm concepts (human beings,
health, nursing, and environment) that are central to their meaning in the
context of the particular framework and the discipline of nursing.

n Nursing conceptual models provide perspectives with different foci for
critical thinking about persons, families, and communities, and for making
knowledgeable nursing decisions.

12C H A P T E R

Myra Estrin Levine

1921 to 1996

The Conservation Model

Karen Moore Schaefer

“Nursing is human interaction”
(Levine, 1973, p. 1).

Credentials and Background of the University of Illinois (1962 to 1963, 1977 to 1987).
Theorist* She chaired the Department of Clinical Nursing at
Cook County School of Nursing (1963 to 1967) and
Myra Estrin Levine enjoyed a varied career. She was coordinated the graduate nursing program in oncology
a private duty nurse (1944), a civilian nurse in the at Rush University (1974 to 1977). Levine was director
U.S. Army (1945), a preclinical instructor in the of the Department of Continuing Education at Evanston
physical sciences at Cook County (1947 to 1950), di- Hospital (March to June 1974) and consultant to the
rector of nursing at Drexel Home in Chicago (1950 to department (July 1974 to 1976). She was adjunct as-
1951), and surgical supervisor at both the University sociate professor of Humanistic Studies at the Univer-
of Chicago Clinics (1951 to 1952) and the Henry Ford sity of Illinois (1981 to 1987). In 1987, she became a
Hospital in Detroit (1956 to 1962). Levine worked her Professor Emerita, Medical Surgical Nursing, at the
way up the academic ranks at Bryan Memorial Hospi- University of Illinois at Chicago. In 1974, Levine went
tal in Lincoln, Nebraska (1951), Cook County School to Tel-Aviv University, Israel, as a visiting associate
of Nursing (1963 to 1967), Loyola University (1967 professor and returned as a visiting professor in 1982.
to 1973), Rush University (1974 to 1977), and the She also was a visiting professor at Recanati School of

*The information in this section is informed by Levine’s autobiographical chapter (1988a), her curriculum vitae, and the program
from the Mid-Year Convocation, Loyola University, Chicago (1992).
Previous authors: Karen Moore Schaefer, Gloria S. Artigue, Karen J. Foil, Tamara Johnson, Ann Marriner Tomey, Mary Carolyn
Poat, LaDema Poppa, Roberta Woeste, and Susan T. Zoretich.
204

Nursing, Ben Gurion University of the Negev, at Beer CHAPTER 12  Myra Estrin Levine 205
Sheva, Israel (March to April, 1982).
the conservation principles at nurse theory confer-
Levine received numerous honors, including charter ences, some of which have been audiotaped, and at
fellow of the American Academy of Nursing (1973), the Allentown College of St. Francis de Sales (now
honorary member of the American Mental Health Aid DeSales University) Conference.
to Israel (1976), and honorary recognition from the
Illinois Nurses Association (1977). She was the first Levine (1989) published a substantial change and
recipient of the Elizabeth Russell Belford Award for clarification about her theory in “The Four Conserva-
excellence in teaching from Sigma Theta Tau (1977). tion Principles: Twenty Years Later.” She elaborated on
Both the first and second editions of her book, Introduc- how redundancy characterizes availability of adaptive
tion to Clinical Nursing (Levine, 1969a; 1973) received responses when stability is threatened. Adaptation pro-
American Journal of Nursing Book of the Year awards, cesses establish a body economy to safeguard individual
and her book, Renewal for Nursing, was translated into stability. The outcome of adaptation is conservation.
Hebrew (Levine, 1971a). Levine was listed in Who’s
Who in American Women (1977 to 1988) and in Who’s She explicitly linked health to the process of conser-
Who in American Nursing (1987). She was elected fel- vation to clarify that the Conservation Model views
low of the Institute of Medicine of Chicago (1987 to health as one of its essential components (Levine, 1991).
1991). The Alpha Lambda Chapter of Sigma Theta Tau Conservation, through treatment, focuses on integrity
recognized Levine for her outstanding contributions and the reclamation of oneness of the whole person.
to nursing in 1990. In January 1992, she was awarded
an honorary doctorate of humane letters from Loyola Levine died on March 20, 1996, at 75 years of age.
University, Chicago (Mid-Year Convocation, Loyola She leaves a legacy as an administrator, educator,
University, 1992). Levine was an active leader in the friend, mother, nurse, scholar, student of humanities,
American Nurses Association and the Illinois Nurses and wife (Pond, 1996). Dr. Baumhart, President of
Association. After her retirement in 1987, she remained Loyola University, said the following of Levine (Mid-
active in theory development and encouraged questions Year Convocation, Loyola University, 1992):
and research about her theory (Levine, 1996).
Mrs. Levine is a renaissance woman . . . who uses
A dynamic speaker, Levine was a frequent pre- knowledge from several disciplines to expand the
senter of programs, workshops, seminars, and panels, vision of health needs of persons that can be met
and a prolific writer regarding nursing and education. by modern nursing. In the Talmudic tradition of
She also served as a consultant to hospitals and her ancestors, [she] has been a forthright spokes-
schools of nursing. Although she never intended to person for social justice and the inherent dignity of
develop theory, she provided an organizational struc- [the] human person as a child of God (p. 6).
ture for teaching medical-surgical nursing and a stim-
ulus for theory development (Stafford, 1996). “The Theoretical Sources
Four Conservation Principles of Nursing” was the
first statement of the conservation principles (Levine, From Beland’s (1971) presentation of the theory of
1967a). Other preliminary work included “Adaptation specific causation and multiple factors, Levine learned
and Assessment: A Rationale for Nursing Interven- historical viewpoints of diseases and learned that the
tion,” “For Lack of Love Alone,” and “The Pursuit of way people think about disease changes over time.
Wholeness” (Levine, 1966b, 1967b, 1969b). The first Beland directed Levine’s attention to numerous authors
edition of her book using the conservation principles, who became influential in her thinking, including
Introduction to Clinical Nursing, was published in Goldstein (1963), Hall (1966), Sherrington (1906),
1969 (Levine, 1969a). Levine addressed the conse- and Dubos (1961, 1965). Levine uses Gibson’s (1966)
quences of the four conservation principles in Holistic definition of perceptual systems, Erikson’s (1964) dif-
Nursing (Levine, 1971b). The second edition of Intro- ferentiation between total and whole, Selye’s (1956)
duction to Clinical Nursing was published in 1973 stress theory, and Bates’ (1967) models of external
(Levine, 1973). After that, Levine (1984) presented environment. Levine was proud that Rogers (1970) was
her first editor. She acknowledged Nightingale’s contri-
bution to her thinking about the “guardian activity” of
observation used by nurses to “save lives and increase
health and comfort” (Levine, 1992, p. 42).

206 UNIT III  Nursing Conceptual Models

MAJOR CONCEPTS & DEFINITIONS of failed redundancy of physiological and psycho-
The three major concepts of the Conservation logical processes” (p. 6).
Model are (1) wholeness, (2) adaptation, and (3)
conservation. Environment
Levine (1973) also views individuals as having their
Wholeness (Holism) own environment, both internally and externally.
“Whole, health, hale are all derivations of the Anglo- Nurses can relate to the internal environment as
Saxon word hal” (Levine, 1973, p. 11). Levine based the physiological and pathophysiological aspects
her use of wholeness on Erikson’s (1964, 1968) of the patient. Levine uses Bates’ (1967) definition of
description of wholeness as an open system. Levine the external environment and suggests the following
(as cited in 1969a) quotes Erikson, who states, three levels:
“Wholeness emphasizes a sound, organic, progres- 1. Perceptual
sive mutuality between diversified functions and 2. Operational
parts within an entirety, the boundaries of which are 3. Conceptual
open and fluent” (p. 94). Levine (1996) believed that
Erikson’s definition set up the option of exploring These levels give dimension to the interactions
the parts of the whole to understand the whole. between individuals and their environments. The
Integrity means the oneness of the individuals, perceptual level includes aspects of the world that
emphasizing that they respond in an integrated, individuals are able to intercept and interpret with
singular fashion to environmental challenges. their sense organs. The operational level contains
things that affect individuals physically, although
Adaptation they cannot directly perceive them, things such as
“Adaptation is a process of change whereby the indi- microorganisms. At the conceptual level, the envi-
vidual retains his integrity within the realities of his ronment is constructed from cultural patterns,
internal and external environment” (Levine, 1973, characterized by a spiritual existence and mediated
p. 11). Conservation is the outcome. Some adapta- by the symbols of language, thought, and history
tions are successful and some are not. Adaptation is (Levine, 1973).
a matter of degree, not an all-or-nothing process.
There is no such thing as maladaptation. Organismic Response
The capacity of individuals to adapt to their envi-
Levine (1991) speaks of the following three char- ronmental conditions is called the organismic re-
acteristics of adaptation: sponse. It is divided into the following four levels
1. Historicity of integration:
2. Specificity 1. Fight or flight
3. Redundancy 2. Inflammatory response
3. Response to stress
She states, “. . . every species has fixed patterns 4. Perceptual awareness
of responses uniquely designed to ensure success
in essential life activities, demonstrating that Treatment focuses on the management of these
adaptation is both historical and specific” (p. 5). responses to illness and disease (Levine, 1969a).
In addition, adaptive patterns may be hidden in
individuals’ genetic codes. Redundancy represents Fight or Flight
the fail-safe options available to individuals to The most primitive response is the fight or flight
ensure adaptation. Loss of redundant choices syndrome. Individuals perceive that they are
through trauma, age, disease, or environmental threatened, whether or not a threat actually exists.
conditions makes it difficult for individuals to Hospitalization, illness, and new experiences elicit
maintain life. Levine (1991) suggests that “the a response. Individuals respond by being on the
possibility exists that aging itself is a consequence

CHAPTER 12  Myra Estrin Levine 207

MAJOR CONCEPTS & DEFINITIONS—cont’d

alert to find more information and to ensure their nursing is required (Levine, 1973, pp. 193–195). The
safety and well-being (Levine, 1973). primary focus of conservation is keeping together
the wholeness of individuals. Although nursing
Inflammatory Response interventions may deal with one particular conser-
This defense mechanism protects the self from vation principle, nurses also must recognize the
insult in a hostile environment. It is a way of heal- influence of the other conservation principles
ing. The response uses available energy to remove (Levine, 1990).
or keep out unwanted irritants and pathogens. It is
limited in time because it drains the individual’s Levine’s (1973) model stresses nursing interac-
energy reserves. Environmental control is impor- tions and interventions that are intended to promote
tant (Levine, 1973). adaptation and maintain wholeness. These interac-
tions are based on the scientific background of the
Response to Stress conservation principles. Conservation focuses on
Selye (1956) described the stress response syndrome achieving a balance of energy supply and demand
to predictable, non–specifically induced organismic within the biological realities unique to each indi-
changes. The wear and tear of life is recorded on the vidual. Nursing care is based on scientific knowl-
tissues and reflects long-term hormonal responses edge and nursing skills. There are four conservation
to life experiences that cause structural change. It is principles.
characterized by irreversibility and influences the
way patients respond to nursing care. Conservation Principles
The goals of the Conservation Model are achieved
Perceptual Awareness through interventions that attend to the conservation
This response is based on the individual’s perceptual principles.
awareness. It occurs only as individuals experience
the world around them. Individuals use responses Conservation of Energy
to seek and maintain safety. It is the ability to gather The individual requires a balance of energy and a
information and convert it to a meaningful experi- constant renewal of energy to maintain life activi-
ence (Levine, 1967a, 1969b). ties. Processes such as healing and aging challenge
that energy. This second law of thermodynamics
Trophicognosis applies to everything in the universe, including
Levine (1966a) recommended trophicognosis as an people.
alternative to nursing diagnosis. It is a scientific
method of reaching a nursing care judgment. Conservation of energy has long been used in
nursing practice, even with the most basic proce-
Conservation dures. Nursing interventions “scaled to the indi-
Conservation is from the Latin word conservatio, vidual’s ability are dependent upon providing care
which means “to keep together” (Levine, 1973). that makes the least additional demand possible”
“Conservation describes the way complex systems (Levine, 1990, pp. 197–198).
are able to continue to function even when severely
challenged” (Levine, 1990, p. 192). Through conser- Conservation of Structural Integrity
vation, individuals are able to confront obstacles, Healing is a process of restoring structural and func-
adapt accordingly, and maintain their uniqueness. tional integrity through conservation in defense of
“The goal of conservation is health and the strength wholeness (Levine, 1991). The disabled are guided to
to confront disability” as “. . . the rules of conserva- a new level of adaptation (Levine, 1996). Nurses can
tion and integrity hold” in all situations in which limit the amount of tissue involved in disease by early
recognition of functional changes and by nursing
interventions.

Continued

208 UNIT III  Nursing Conceptual Models

MAJOR CONCEPTS & DEFINITIONS—cont’d

Conservation of Personal Integrity manifested through holiness, a testament to spiritu-
Self-worth and a sense of identity are important. ality in all people. “The conservation of personal
The most vulnerable become patients. This begins integrity includes recognition of the holiness of
with the erosion of privacy and the creation of each person” (Levine, 1996, p. 40).
anxiety. Nurses can show patients respect by calling
them by name, respecting their wishes, valuing per- Conservation of Social Integrity
sonal possessions, providing privacy during proce- Life gains meaning through social communities,
dures, supporting their defenses, and teaching and health is socially determined. Nurses fulfill
them. “The nurse’s goal is always to impart knowl- professional roles, provide for family members,
edge and strength so that the individual can resume assist with religious needs, and use interpersonal
a private life—no longer a patient, no longer depen- relationships to conserve social integrity (Levine,
dent” (Levine, 1990, p. 199). The sanctity of life is 1967b, 1969a).

Use of Empirical Evidence • “Every self-sustaining system monitors its own
behavior by conserving the use of the resources
Levine (1973) believed that specific nursing activities required to define its unique identity” (Levine,
could be deducted from scientific principles. The sci- 1991, p. 4).
entific theoretical sources have been well researched.
She based much of her work on accepted science • Human beings respond in a singular, yet integrated,
principles. fashion (Levine, 1971a).

Major Assumptions Nursing
Levine (1973) stated the following about nursing:
Introduction to Clinical Nursing is a text for beginning
nursing students that uses the conservation principles Nursing is a human interaction (p. 1). Professional
as an organizing framework (Levine, 1969a, 1973). nursing should be reserved for those few who can
Although she did not state them specifically as as- complete a graduate program as demanding as
sumptions, Levine (1973) valued “a holistic approach that expected of professionals in any other disci-
to care of all people, well or sick” (p. 151). Her respect pline . . . There will be very few professional nurses
for the individuality of each person is noted in the (Levine, 1965, p. 214).
following statements:
Nursing practice is based on nursing’s unique
Ultimately, decisions for nursing interventions knowledge and the scientific knowledge of other dis-
must be based on the unique behavior of the ciplines adjunctive to nursing knowledge (Levine,
individual patient. . . . Patient centered nursing 1988b), as follows:
care means individualized nursing care . . . and
as such he requires a unique constellation of It is the nurse’s task to bring a body of scientific
skills, techniques, and ideas designed specifically principles, on which decisions depend, into the
for him (1973, p. 6). precise situation that she shares with the patient.
Sensitive observation and the selection of rele-
Schaefer (1996) identified the following statements vant data form the basis for her assessment of his
as assumptions about the model: nursing requirements.
• The person can be understood only in the context
The nurse participates actively in every patient’s
of his or her environment (Levine, 1973). environment and much of what she does supports

his adjustments as he struggles in the predicament CHAPTER 12  Myra Estrin Levine 209
of illness (Levine, 1966b, p. 2452). backdrop. “The individual actively participates in his
environment” (Levine, 1973, p. 443). Levine discussed
The essence of Levine’s theory is as follows: the importance of the internal and external environ-
ment to the determinant of nursing interventions to
. . . when nursing intervention influences adap- promote adaptation. “All adaptations represent the
tation favorably, or toward renewed social well- accommodation that is possible between the internal
being, then the nurse is acting in a therapeutic and external environment” (p. 12).
sense; when the response is unfavorable, the
nurse provides supportive care (1966b, p. 2450). Theoretical Assertions

The goal of nursing is to promote adaptation Although many theoretical assertions can be generated
and maintain wholeness (1971b, p. 258). from Levine’s work, the four major assertions follow:
1 . “Nursing intervention is based on the conserva-
Person
Person is described as a holistic being; wholeness is tion of the individual patient’s energy” (Levine,
integrity (Levine, 1991). Integrity means that the per- 1967a, p. 49).
son has freedom of choice and movement. The person 2 . “Nursing intervention is based on the conserva-
has a sense of identity and self-worth. Levine also tion of the individual patient’s structural integrity”
described person as a “system of systems, and in its (Levine, 1967a, p. 56).
wholeness expresses the organization of all the con- 3 . “Nursing intervention is based on the conserva-
tributing parts” (pp. 8–9). Persons experience life as tion of the individual patient’s personal integrity”
change through adaptation with the goal of conserva- (Levine, 1967a, p. 56).
tion. According to Levine (1989), “The life process is 4. “Nursing intervention is based on the conservation
the process of change” (p. 326). of the individual patient’s social integrity” (Levine,
1967b, p. 179).
Health Levine (1991) provided some thoughts about two
Health is socially determined by the ability to func- theories in their early stages of development. The the-
tion in a reasonably normal manner (Levine, 1969b). ory of therapeutic intention is intended to provide the
Social groups predetermine health. Health is not just basis of nursing interventions that focus on biological
an absence of pathological conditions. Health is the realities of the patient. Although not planned as such,
return to self; individuals are free and able to pursue the theory naturally flows from the conservation prin-
their own interests within the context of their own ciples. The theory of redundancy expands the redun-
resources. Levine stressed the following: dancy domain of adaptation and offers explanations
for redundant options such as those found in aging
It is important to keep in mind that health is also and the physiological adaptation of a failing heart.
culturally determined—it is not an entity on its
own, but rather a definition imparted by the Logical Form
ethos and beliefs of the groups to which individu-
als belong Levine primarily uses deductive logic. In developing
her model, Levine integrates theories and concepts
(M. Levine, personal communication, from the humanities and the sciences of nursing,
February 21, 1995). physiology, psychology, and sociology. She uses the
information to analyze nursing practice situations
Even for a single individual, the definition of and describe nursing skills and activities. With the
health will change over time. assistance of many of her students and colleagues,
and through her own personal health encounters,
Environment Levine has experienced the Conservation Model and
Environment is conceptualized as the context in its principles operating in practice.
which individuals live their lives. It is not a passive

210 UNIT III  Nursing Conceptual Models early discussion of death and dying and believed that
women should be awakened after a breast biopsy and
Applications to the Nursing Community consulted about the next step.
Practice
Introduction to Clinical Nursing provides an orga-
Levine helps define what nursing is by identifying the nizational structure for teaching medical-surgical
activities it encompasses and giving the scientific nursing to beginning students (Levine, 1969a, 1973).
principles behind them. Conservation principles, In both the 1969 and 1973 editions, Levine presents a
levels of integration, and other concepts can be used model at the end of each of the first nine chapters.
in numerous contexts (Fawcett, 2000; Levine, 1990, Each model contains objectives, essential science con-
1991). Hirschfeld (1976) has used the principles of cepts, and nursing process to give nurses a foundation
conservation in the care of the older adult. Savage for nursing activities. These models are not part of
and Culbert (1989) used the Conservation Model the Conservation Model. The Conservation Model
to establish a plan of care for infants. Dever (1991) is addressed in the Introduction and in Chapter 10
based her care of children on the Conservation Model. of the introductory text. The teachers’ manual that
Roberts, Fleming, and Yeates-Giese (1991) designed accompanies the text remains a timely source of edu-
interventions for women in labor based on the Con- cational principles that may be helpful to both begin-
servation Model. Mefford (2000; Mefford & Alligood, ning and seasoned teachers (Levine, 1971c).
2011a, 2011b) tested a Middle Range Theory of Health
Promotion for Preterm Infants based on Levine’s Although the text is labeled introductory, beginning
Conservation Model of nursing and found a signifi- students would have benefited from a background in
cant inverse relationship between the consistency of physical and social sciences to use it. An emphasis of
the caregiver and the age at which the infant achieved scientific principles in the second edition bridged this
health, and an inverse relationship between the use gap. Evidence supporting the model has been integrated
of resources by preterm infants during the initial hos- successfully into undergraduate and graduate curricula
pital stay and the consistency of caregivers. Cooper (Grindley & Paradowski, 1991; Schaefer, 1991a).
(1990) developed a framework for wound care focus-
ing on structural integrity while integrating all the Research
integrities. Leach (2007) published a white paper on Levine’s Model has been successfully used to develop
use of the Conservation Model to guide wound care nursing knowledge (Schaefer & Pond, 1991). However,
practices. Webb (1993) used the Conservation Model Fawcett (1995) states that to establish credibility, “more
to provide care for patients undergoing cancer treat- systematic evaluations of the use of the model in vari-
ment. Roberts, Brittin, and deClifford (1995) and ous clinical situations are needed, as are studies that
Roberts, Brittin, Cook, and deClifford (1994) used test conceptual-theoretical-empirical structures di-
the Conservation Model to study the boomerang pil- rectly derived from or linked with the conservation
low technique effect on respiratory capacity. Jost principles” (p. 208). Many research questions can be
(2000) used the model to develop an assessment of generated from Levine’s model (Radwin & Fawcett,
the needs of staff during the experience of change. 2002; Schaefer, 1991b). Graduate students and clinical
researchers have used the conservation principles as a
Conservation principles have been used as a framework to guide their research (Ballard, Robley,
framework for numerous practice settings in cardiol- Barrett, et al., 2006; Cox, 1988; Gagner-Tjellesen,
ogy, obstetrics, gerontology, acute care (neurology), Yurkovich, & Gragert, 2001; Mefford, 2000; Mefford &
pediatrics, long-term care, emergency care, primary Alligood, 2011a, 2011b; Moch, St. Ours, Hall, et al.,
care, neonatology, critical care, and in the homeless 2007). Ballard and colleagues used the model to frame
community (Savage & Culbert, 1989; Schaefer & their phenomenological study of how participants re-
Pond, 1991). constructed their lives with paraplegia. They found that
Education structural integrity, along with all the other integrities,
Levine (1973) wrote Introduction to Clinical Nursing was used as a basis for defining their new lives.
as a textbook for beginning students. It introduced
new material into the curricula. She presented an One of the most important questions to be asked
about the model is: What are the human experiences

not explained by the model? This question can pro- CHAPTER 12  Myra Estrin Levine 211
vide guidance for continued testing of the model’s
application in nursing practice. For example, as health Accessibility
care providers use information from the human Levine used deductive logic to develop her model,
genome project, nurse researchers will want to test which can be used to generate research questions. As
the ability of the model to explain comprehensive she lived her Conservation Model, she verified the
nursing care of the client undergoing genetic counsel- use of inductive reasoning to further develop and in-
ing. Based on the outcome of testing, hypotheses can form her model (M. Levine, personal communication,
be developed and tested to support the prescriptive May 17, 1989).
basis of theories developed from the model. Importance
The four conservation principles defined in Levine’s
Further Development model are recognized as one of the earliest nursing
models used to organize and clarify elements of nurs-
Levine and others have worked on using the conser- ing practice. Furthermore, the model continues to
vation principles as the basis for a nursing diagnosis demonstrate evidence of its utility for nursing practice
taxonomy (Stafford, 1996; Taylor, 1989). Additional and research and is receiving increased recognition in
work has been done on the use of Levine’s model in the twenty-first century.
administration and with the frail elderly. The model
was used to develop and test the Theory of Health Summary
Promotion in Preterm Infants based on Levine’s Con-
servation Model (Mefford, 2000; Mefford & Alligood, Levine developed her Conservation Model to provide
2011a, 2011b) and has great potential for studies of a framework within which to teach beginning nursing
sleep disorders and in the development of collabora- students. In the first chapter of her book, she intro-
tive and primary care practices (Fawcett, 2000). The duces her assumptions about holism, and that the
philosophical, ethical, and spiritual implications of conservation principles support a holistic approach to
the model are research challenges yet to be realized patient care (Levine, 1969a, 1973). The model is logi-
(Stafford, 1996). cally congruent, is externally and internally consis-
tent, has breadth as well as depth, and is understood,
Critique with few exceptions, by professionals and consumers
Clarity of health care. Nurses using the Conservation Model
can anticipate, explain, predict, and perform patient
Levine’s model possesses clarity. Fawcett (2000) states, care. However, its ability to predict outcomes must be
“. . . Levine’s Conservation Model provides nursing tested further. Levine (1990) said, “. . . everywhere
with a logically congruent, holistic view of the person” that nursing is essential, the rules of the conservation
(p. 189). George (2002) affirms, “this theory directs and the integrity hold” (p. 195).
nursing actions that lead to favorable outcomes”
(p. 237). The model has numerous terms; however, CASE STUDY*
Levine adequately defines them for clarity. Yolanda is a 55-year-old married African-American
Simplicity mother of two adult children who has a history
Although the four conservation principles appear sim- of breast cancer. She was diagnosed with fibromyal-
ple initially, they contain subconcepts and multiple gia 2 years ago, following years of unexplained
variables. Nevertheless, this model is still one of the muscle aches and what she thought was arthritis.
simpler ones developed. The diagnosis was a relief for her; she was able to
Generality read about it and learn how to care for herself.
The four conservation principles can be used in all Over the past 2 months, Yolanda stopped taking
nursing contexts. all of her medicine, because she was seeing a new
physician and wanted to start her care at ground
zero. In addition to her family responsibilities, she

Continued

212 UNIT III  Nursing Conceptual Models gas results have always been within normal limits.
is completing her degree as an English major. At Most diagnostic study values are within normal
the time of her appointment, she told the nurse limits in patients with fibromyalgia, making treat-
practitioner that she was having the worst pain ment difficult.
possible.
Using Levine’s Conservation Model, the nurse Conservation of structural integrity involves
practitioner completed a comprehensive assess- maintaining the structure of the body to promote
ment in preparation for developing a plan of care healing. Because there is no known cause of fibro-
in consultation with the physician. Nursing care is myalgia, treatment focuses on reducing symptoms.
organized according to the conservation princi- Yolanda’s symptoms could not be traced to any
ples, with consideration of how the individual physical or structural alteration, yet she reports
adapts to the internal and external environments. severe pain and fatigue. The nurse practitioner
Yolanda’s diagnosis of fibromyalgia was based on knows that it is important to acknowledge the reality
the exclusion of other illnesses with a cluster of of the symptoms and work with the client to deter-
symptoms, including pain, fatigue, and sleepless- mine if activities of daily living result in changes in
ness (e.g., systemic lupus erythematosus, multiple the pattern of illness. In addition, Yolanda thinks she
sclerosis). Laboratory and other diagnostic results is going through menopause, and she is having
all were within normal limits. trouble determining if her symptoms are caused by
The external environment includes perceptual, menopause or fibromyalgia.
operational, and conceptual factors. Perceptual
factors are those that are perceived through the With continued questioning, the nurse practitio-
senses. Yolanda reported a history of unexplained ner learns that Yolanda was diagnosed with irritable
fatigue and pain for years. She recently stopped bowel syndrome several years earlier. She is not
her medications “to clean my body out.” However, worried about constipation but is concerned about
she reported that the pain became unbearable and sudden diarrhea. She is afraid to go to school; she
was making it difficult for her to sleep. She noted fears embarrassment because she might have an
that when she sleeps at least 6 hours a night, her “accident.” Yolanda was taking several medications
pain is less intense. With the current insomnia, for her discomfort. One of them made her feel so
her pain is very intense. “hung over” that she stopped taking it after 2 weeks.
Operational factors are threats to the environment She was given amitriptyline (Elavil) for sleep. It was
that the client cannot perceive through the senses. the only medicine that helped her get 6 hours of
Yolanda reported severe pain in response to both the continuous sleep.
cold weather and changes in barometric pressure.
The conceptual environment includes cultural Personal integrity involves the maintenance of
and personal values about health care, the meaning one’s sense of personal worth and self-esteem.
of health and illness, knowledge about health care, Yolanda reported that she lost control when she
education, language use, and spiritual beliefs. In was diagnosed with breast cancer. A dear friend
response to breast cancer, Yolanda developed her convinced her to go to church and encouraged her
spirituality through prayer and reading the Bible. to use prayer. When feeling sorry for herself, she
She believes that this is how she gets through the would go into her bedroom and read her Bible, cry
painful moments of her current illness. by herself, and pray. She believes that prayer and
Conservation of energy focuses on the balance Bible reading helped her heal. She continues to
of energy input and output to prevent excessive pray and read her Bible to gain the strength she
fatigue. Yolanda complains of a fatigue that just needs to live with her illness. She also believes that
“comes over me.” She has difficulty doing house- she needs to be able to laugh at herself; humor
work. One day of work usually means one day in helps her to feel better. She actively seeks health
bed because of extreme fatigue. Her hemoglobin information, as indicated by her quest to learn
level and hematocrit are normal; her arterial blood about her new diagnosis of fibromyalgia. She is
most upset about not being able to walk like
she used to walk. One of her favorite pastimes

CHAPTER 12  Myra Estrin Levine 213

was shopping for shoes at the mall, which now is prayer, Bible reading, and humor to help her feel
difficult for her. better, (3) discuss medication therapy and what
might help her achieve restful sleep, (4) refer her
Social integrity acknowledges that the patient is a for blood work to assess hormone levels, and
social being. Yolanda is a married mother of three (5) assist her with determining the meaning of
grown children. She keeps a lot of her feelings from the symptoms (e.g., menopause or fibromyalgia).
her children but does share them with her husband. Yolanda indicated that when she was able to get
He is a major source of support for her. He takes her 6 hours of uninterrupted sleep, her pain was less
food shopping and makes sure that she gets to her intense and she felt better. Finding both medication-
appointments on time. She shared at the time of induced and nonpharmaceutical approaches to
her visit that she wants to have a picnic for her improve sleep is a high priority.
birthday, but the only way she can do it is to ask her
grandchildren to help her husband clean the yard. The nurse practitioner will assess the outcome
of Yolanda’s care based on the organismic re-
Yolanda is a middle-aged woman with a history sponses. The following predicted responses suggest
of severe pain, sleeplessness, and fatigue. Diagnostic adaptation:
studies have been unrevealing, with the exception n Reports comfort as a result of prayer, Bible
of multiple tender points. The history of pain and
positive tender points supported the diagnosis of reading, and humor
fibromyalgia. She has stopped taking all medications n Distinguishes symptoms of menopause from
and reports that she may be going through meno-
pause. She reports severe pain and fatigue that make symptoms of fibromyalgia
it difficult for her to sleep and to do normal house- n Reports feeling rested after 6 hours of unin-
work. Her husband and grandchildren are available
to help with chores at home, and she seeks the sup- terrupted sleep
port of prayer and reading her Bible to ease her n Reports a perceived reduction in pain and
discomfort. She also finds that humor helps her to
feel better. fatigue
n Collaborates with health care providers to
The initial plan of care includes (1) validate the
illness experience, (2) encourage continued use of manage symptoms of menopause

*This case study is based on raw data from a completed study (Schaefer,
2005). Yolanda is a fictitious name used to protect the privacy and anonymity
of the participant.

CRITICAL THINKING ACTIVITIES appropriate interventions using Levine’s conserva-
tion principles.
1. Keep a reflective journal about a personal health 4 . Watch one of the following movies: City of Joy,
or illness experience or that of someone very close. Soul Food, The Secret Garden, Courageous, or
Reflect on its consistency with the Conservation The Descendents. Use examples from the movie
Model—how to modify, expand, or delimit the to support or refute Levine’s propositional
model to provide a context for explanation. statements.
5. Apply the Conservation Model to a pathography
2. Levine stated, “Health is culturally determined; it such as Love and Other Infectious Diseases by
is not an entity on its own, but rather a definition Molly Haskell, and explain life with illness.
imparted by the ethos and beliefs of groups to 6. Identify what may be missing in simulation expe-
which the individual belongs” (M. Levine, riences of nursing practice from the perspective
personal communication, February, 21, 1995). of this nursing model. Suggest how you might
develop your style of nursing practice to encom-
3. Visit a museum, and evaluate how artistic expres- pass the total patient experience.
sion captures the beliefs of different ethnic groups.
Then explore how these beliefs shape definitions
of health and illness. On the basis of an ethnically
derived definition of health, propose ethnically

214 UNIT III  Nursing Conceptual Models

POINTS FOR FURTHER STUDY n Mayo Clinic—Nursing Theorist—Myra Levine at:
http://www.mayo.edu/education/nursing-research/
n Cardinal Stitch University Library; Nursing levine.html
Theorist: Myra Levine at: http://library.stitch.edu/
research/subjects/nursingtheorists/levine.htm n Nursing for Nurses—Levine Conservation Model
(Blog) at: http://allnurses.com/forums/f76/levine-
n Hahn School of Nursing and Health Science, conservation-model-48040-print.html
University of San Diego at: http://www.sandiego.
edu/nursing/theory/ n Nursing Theories Group E-Levine’s Conservation
Model Concept at: http://nursingtheories.
n Karen Schaefer’s chapter, “Levine’s Conservation blogspot.com2011/07/group-e-levines-
Nursing Model in Nursing Practice” (Chapter
10) in a companion Elsevier text, Alligood n The nursing theorist: Portraits of excellence. Myra
(2010). Nursing theory: Utilization & application, Levine (video, CD, or electronically), by Oakland:
4th edition. Studio III, Oakland, CA. Now available at Fitne,
Inc., 5 Depot Street, Athens, Ohio 45701
n Leach, M. J. Using Levine’s conservation model
to guide practice (white paper) at: http://www.
om.com/article/6024

REFERENCES knowledge: Nursing models and theories (pp. 151–193).
Philadelphia: F. A. Davis.
Ballard, N., Robley, L., Barrett, D., Fraser, D., & Mendoza, I. Gagner-Tjellesen, D., Yurkovich, E. E., & Gragert, M.
(2006). Patients’ recollections of therapeutic paralysis (2001). Use of music therapy and other ITNIs in acute
in the intensive care unit. American Journal of Critical care. Journal of Psychosocial Nursing and Mental Health
Care, 15(1), 86–94. Services, 39(10), 26–37.
George, J. B. (2002). The Conservation Principles: A model
Bates, M. (1967). A naturalist at large. Natural History, for health. In J. George (Ed.) Nursing theories: The base
76(6), 8–16. for professional nursing practice (225–240). Upper Saddle
River, (NJ): Prentice Hall.
Beland, I. (1971). Clinical nursing: Pathophysiological and Gibson, J. E. (1966). The senses considered as perceptual
psychosocial implications (2nd ed.). New York: Macmillan. systems. Boston: Houghton Mifflin.
Goldstein, K. (1963). The organism. Boston: Beacon Press.
Cooper, D. H. (1990). Optimizing wound healing: A prac- Grindley, J., & Paradowski, M. B. (1991). Developing
tice within nursing domains. Nursing Clinics of North an undergraduate program using Levine’s model.
America, 25(1), 165–180. In K. M. Schaefer & J. B. Pond (Eds.), Levine’s Conser-
vation Model: A framework for nursing practice
Cox, B. (1988). Pregnancy, anxiety, and time perception (pp. 199–208). Philadelphia: F. A. Davis.
(Doctoral dissertation, University of Illinois at Chicago, Hall, E. T. (1966). The hidden dimension. Garden City,
Health Science Center, 1988). Dissertation Abstracts (NY): Doubleday.
International, 48, 2260B. (University Microfilms Hirschfeld, M. J. (1976). The cognitively impaired older
No. AA18724993) adult. American Journal of Nursing, 76, 1981–1984.
Jost, S. G. (2000). An assessment and intervention strategy
Dever, M. (1991). Care of children. In K. M. Schaefer & for managing. Journal of Nursing Administration, 30(1),
J. B. Pond (Eds.), The Conservation Model: A frame- 34–40.
work for nursing practice (pp. 71–82). Philadelphia: Leach, M. J. Using Levine’s Conservation Model to Guide
F. A. Davis. Practice (white paper). Available at: http://www.o-m.
com/article/6024.
Dubos, R. (1961). Mirage of health. Garden City, (NY): Levine, M. E. (1965, June). The professional nurse and
Doubleday. graduate education. Nursing Science, 3, 206.
Levine, M. E. (1966a). Trophicognosis: An alternative
Dubos, R. (1965). Man adapting. New Haven, (CT): Yale to nursing diagnosis. American Nurses Association
University Press. Regional Clinical Conferences, 2, 55–70.

Erikson, E. H. (1964). Insight and responsibility. New York:
W. W. Norton.

Erikson, E. H. (1968). Identity: Youth and crisis. New York:
W. W. Norton.

Fawcett, J. (1995). Levine’s Conservation Model. In J. Fawcett
(Ed.), Analysis and evaluation of conceptual models of
nursing (pp. 165–215). Philadelphia: F. A. Davis.

Fawcett J. (2000). Levine’s Conservation Model. In J. Fawcett
(Ed.), Analysis and evaluation of contemporary nursing

Levine, M. E. (1966b). Adaptation and assessment: A rationale CHAPTER 12  Myra Estrin Levine 215
for nursing intervention. American Journal of Nursing, 66,
2450–2454. Levine’s Conservation Model of Nursing. Journal of
Theory Construction and Testing, 15(2), 41–47.
Levine, M. E. (1967a). The four conservation principles of Mefford, L. C., & Alligood, M. R. (2011b). Evaluating
nursing. Nursing Forum, 6, 45–59. nurse staffing patterns and neonatal intensive care
unit outcomes using Levine’s Conservation Model
Levine, M. E. (1967b, Dec.). For lack of love alone. Minnesota of Nursing. Journal of Nursing Management, 19,
Nursing Accent, 39, 179. 998–1011.
Mid-Year Convocation: Loyola University, Chicago.
Levine, M. E. (1969a). Introduction to clinical nursing. (1992). The Conferring of Honorary Degrees by
Philadelphia: F. A. Davis. R. C. Baumhart, Candidate for the degree of Doctor
and Humane Letters, p. 6.
Levine, M. E. (1969b). The pursuit of wholeness, American Moch, V., St. Ours, C., Hall, S., Bositis, A., Tillery, M., Belcher,
Journal of Nursing, 69, 93. A., et al. (2007). Using a conceptual model in nursing
research—mitigating fatigue in cancer patients. Journal
Levine, M. E. (1971a). Renewal for nursing. Philadelphia: of Advanced Nursing, 58(5), 503–512.
F. A. Davis. Nagley, S. J. (1984). Prevention of confusion in hospital-
ized elderly persons (Doctoral dissertation). Disserta-
Levine, M. E. (1971b). Holistic nursing. Nursing Clinics of tion Abstracts International, 48, 1732B. (University
North America, 6, 253–263. Microfilms No. AA18420848) Case Western Reserve
University.
Levine, M. E. (1971c). Instructor’s guide to introduction to Pond, J. B. (1996). Myra Levine, nurse educator and
clinical nursing. Philadelphia: F. A. Davis. scholar dies. Nursing Spectrum, 5(8), 8.
Radwin, L., & Fawcett, J. (2002). A conceptual model
Levine, M. E. (1973). Introduction to clinical nursing (2nd ed.). based programme of nursing research: Retrospective
Philadelphia: F. A. Davis. and prospective applications. Journal of Advanced
Nursing, 40(3), 355–360.
Levine, M. E. (1984, April). A conceptual model for nurs- Roberts, J. E., Fleming, N., & Yeates-Giese, D. (1991).
ing: The four conservation principles. Proceedings Perineal integrity. In K. M. Schaefer & J. B. Pond
from Allentown College of St. Francis Conference, (Eds.), The Conservation Model: A framework for
Philadelphia. nursing practice (pp. 61–70). Philadelphia: F. A. Davis.
Roberts, K. L., Brittin, M., Cook, M., & deClifford, J.
Levine, M. E. (1988a). Myra Levine. In T. M. Schoor & (1994). Boomerang pillows and respiratory capacity.
A. Zimmerman (Eds.), Making choices, taking chances: Clinical Nursing Research, 3(2), 157–165.
Nurse leaders tell their stories (pp. 215–228). St. Louis: Roberts, K. L., Brittin, M., & deClifford, J. (1995). Boomer-
Mosby. ang pillows and respiratory capacity in frail elderly
women. Clinical Nursing Research, 4(4), 465–471.
Levine, M. E. (1988b). Antecedents from adjunctive disci- Rogers, M. E. (1970). An introduction to the theoretical
plines: Creation of nursing theory. Nursing Science basis of nursing. Philadelphia: F. A. Davis.
Quarterly, 1(1), 16–21. Savage, T. A., & Culbert, C. (1989). Early intervention:
The unique role of nursing. Journal of Pediatric Nursing,
Levine, M. E. (1989). The four conservation principles: 4(5), 339–345.
Twenty years later. In J. Riehl (Ed.), Conceptual models Schaefer, K. M. (1991a). Developing a graduate program
for nursing practice (3rd ed., pp. 325–337). New York: in nursing: Integrating Levine’s philosophy. In K. M.
Appleton-Century-Crofts. Schaefer & J. B. Pond (Eds.), Levine’s Conservation
Model: A framework for nursing practice (pp. 209–218).
Levine, M. E. (1990). Conservation and integrity. In M. Parker Philadelphia: F. A. Davis.
(Ed.), Nursing theories in practice (pp. 189–201). New York: Schaefer, K. M. (1991b). Levine’s conservation principles
National League for Nursing. and research. In K. M. Schaefer & J. B. Pond (Eds.),
Levine’s Conservation Model: A framework for nursing
Levine, M. E. (1991). The conservation principles: A practice (pp. 45–60). Philadelphia: F. A. Davis.
model for health. In K. Schaefer & J. Pond (Eds.), Schaefer, K. M. (1996). Levine’s Conservation Model: Car-
Levine’s Conservation Model: A framework for nursing ing for women with chronic illness. In P. H. Walker &
practice (pp. 1–11). Philadelphia: F. A. Davis. B. Neuman (Eds.), Blueprint for use of nursing models:

Levine, M. E. (1992). Nightingale redux. In B. S. Barnum
(Ed.), Nightingale’s notes on nursing (pp. 39–43).
Philadelphia: Lippincott.

Levine, M. E. (1996). The conservation principles: A retro-
spective. Nursing Science Quarterly, 9(1), 38–41.

Mefford, L. C. (2000). The relationships of nursing care to
health outcomes of preterm infants: Testing a theory of
health promotion for preterm infants based on Levine’s
Conservation Model. Unpublished doctoral dissertation,
University of Tennessee, Knoxville.

Mefford, L. C., & Alligood, M. R. (2011a). Testing a theory
of health promotion for preterm infants based on

216 UNIT III  Nursing Conceptual Models Taylor, J. W. (1974). Measuring the outcomes of nursing
care. Nursing Clinics of North America, 9, 337–348.
Education, research, practice and administration.
New York: National League for Nursing. Taylor, J. W. (1989). Levine’s conservation principles: Using
Schaefer, K. M. (2005). The lived experience of fibromyal- the model for nursing diagnosis in a neurological set-
gia in African American women. Holistic Journal of ting. In J. P. Riehl-Sisca (Ed.), Conceptual models for
Nursing, 19(1), 17–25. nursing practice (3rd ed., pp. 349–358). Norwalk, (CT):
Schaefer, K. M., & Pond, J. B. (Eds.) (1991). Levine’s Con- Appleton & Lange.
servation Model: A framework for nursing
practice.Philadelphia: F. A. Davis. Taylor, J. W., & Ballenger, S. (1980). Neurological dysfunc-
Selye, H. (1956). The stress of life. New York: McGraw-Hill. tion and nursing interventions. New York: McGraw-Hill.
Sherrington, A. (1906). Integrative function of the nervous
system. New York: Charles Scribner’s Sons. Webb, H. (1993). Holistic care following a palliative
Stafford, M. J. (1996). In tribute: Myra Estrin Levine, Pro- Hartmann’s procedure. British Journal of Nursing,
fessor Emerita, MSN, RN, FAAN. Chart, 93(3), 5–6. 2(2), 128–132.

BIBLIOGRAPHY Levine, M. E. (1994). Some further thoughts on nursing
rhetoric. In J. F. Kikuchi & H. Simmons (Eds.), Devel-
Primary Sources oping a philosophy of nursing (pp. 104–109). Thousand
Books Oaks, CA: Sage.
Levine, M. E. (1969). Introduction to clinical nursing.
Journal Articles
Philadelphia: F. A. Davis. Levine, M. E. (1963). Florence Nightingale: The legend
Levine, M. E. (1971). Renewal for nursing. Philadelphia:
that lives. Nursing Forum, 2(4), 24–35.
F. A. Davis. [Translated into Hebrew, Am Oved, Levine, M. E. (1964). Not to startle, though the way were
Jerusalem, 1978.]
Levine, M. E. (1973). Introduction to clinical nursing steep. Nursing Science, 2, 58–67.
(2nd ed.). Philadelphia: F. A. Davis. Levine, M. E. (1964). There need be no anonymity. First,

Book Chapters 18(9), 4.
Levine, M. E. (1964). Nursing service. In M. Leeds & H. Levine, M. E. (1965). The professional nurse and graduate

Shore (Eds.), Geriatric institutional management. education. Nursing Science, 3, 206–214.
New York: Putnam. Levine, M. E. (1965). Trophicognosis: An alternative to nurs-
Levine, M. E. (1973). Adaptation and assessment: A
rationale for nursing intervention. In M. E. Hardy ing diagnosis. ANA Regional Clinical Conferences, 2, 55–70.
(Ed.), Theoretical foundations for nursing. New York: Levine, M. E. (1966). Adaptation and assessment: A ratio-
Irvington.
Levine, M. E. (1988). Myra Levine. In T. M. Schorr & nale for nursing intervention. American Journal of
A. Zimmerman (Eds.), Making choices, taking chances: Nursing, 66(11), 2450–2453.
Nursing leaders tell their stories. St. Louis: Mosby. Levine, M. E. (1967). For lack of love alone. Minnesota
Levine, M. E. (1989). The four conservation principles: Nursing Accent, 39(7), 179–202.
Twenty years later. In J. Riehl (Ed.), Conceptual models for Levine, M. E. (1967). Medicine-nursing dialogue belongs
nursing practice (3rd ed.). New York: Appleton-Century- at patient’s bedside. Chart, 64(5), 136–137.
Crofts. Levine, M. E. (1967). The four conservation principles of
Levine, M. E. (1990). Conservation and integrity. In M. Parker nursing. Nursing Forum, 6, 45–59.
(Ed.), Nursing theories in practice (pp. 189–201). New York: Levine, M. E. (1967). This I believe: About patient-centered
National League for Nursing. care. Nursing Outlook, 15, 53–55.
Levine, M. E. (1991). The conservation principles: A Levine, M. E. (1968). Knock before entering personal
model for health. In K. Schaefer & J. Pond (Eds.), space bubbles (part 1). Chart, 65(2), 58–62.
Levine’s Conservation Model: A framework for nursing Levine, M. E. (1968). Knock before entering personal
practice (pp. 1–11). Philadelphia: F. A. Davis. space bubbles (part 2). Chart, 65(3), 82–84.
Levine, M. E. (1992). Nightingale redux. In B. S. Barnum Levine, M. E. (1968). The pharmacist in the clinical setting:
(Ed.), Nightingale’s notes on nursing: Commemorative edi- A nurse’s viewpoint. American Journal of Hospital Phar-
tion with commentaries by nursing theorists. Philadelphia: macy, 25(4), 168–171. [Also translated into Japanese and
Lippincott. published in Kyushu National Hospital Magazine for
Western Japan.]

Levine, M. E. (1969, Feb.). Constructive student power. CHAPTER 12  Myra Estrin Levine 217
Chart, 66(2), 42FF.
Levine, M. E. (1982). The bioethics of cancer nursing.
Levine, M. E. (1969). Small hospital—Big nursing. Chart, Journal of Enterostomal Therapy, 9, 11–13.
66(10), 265–269.
Levine, M. E. (1988). Antecedents from adjunctive disci-
Levine, M. E. (1969). Small hospital—Big nursing. Chart, plines: Creation of nursing theory. Nursing Science
66(11), 310–315. Quarterly, 1(1), 16–21.

Levine, M. E. (1969). The pursuit of wholeness. American Levine, M. E. (1988). What does the future hold for nurs-
Journal of Nursing, 69, 93–98. ing? 25th Anniversary Address, 18th District. Illinois
Nurses Association Newsletter, XXIV(6), 1–4.
Levine, M. E. (1970). Dilemma. ANA Clinical Conferences,
338–342. Levine, M. E. (1989). Beyond dilemma. Seminars in Oncol-
ogy Nursing, 5, 124–128.
Levine, M. E. (1970). Breaking through the medications
mystique. American Journal of Hospital Pharmacy, Levine, M. E. (1989). Ration or rescue: The elderly in critical
27(4), 294–299; American Journal of Nursing, 70(4), care. Critical Care Nursing, 12(1), 82–89.
799–803.
Levine, M. E. (1989). The ethics of nursing rhetoric. Image:
Levine, M. E. (1970). Symposium on a drug compendium: The Journal of Nursing Scholarship, 21(1), 4–5.
View of a nursing educator. Drug Information Journal,
4, 133–135. Levine, M. E. (1995). The rhetoric of nursing theory. Im-
age: The Journal of Nursing Scholarship, 27(1), 11–14.
Levine, M. E. (1970). The intransigent patient. American
Journal of Nursing, 70, 2106–2111. Levine, M. E. (1996). On the humanities in nursing. Cana-
dian Journal of Nursing Research, 27(2), 19–23.
Levine, M. E. (1971). Consider implications for nursing in
the use of physician’s assistant. Hospital Topics, 49, 60–63. Levine, M. E. (1996). The conservation principles: A retro-
spective. Nursing Science Quarterly, 9(1), 38–41.
Levine, M. E. (1971). Holistic nursing. Nursing Clinics of
North America, 6, 253–264. Levine, M. E. (1997). On creativity in nursing. Image: The
Journal of Nursing Scholarship, 29(3), 216–217.
Levine, M. E. (1971). The time has come to speak of health
care. AORN Journal, 13, 37–43. Levine, M. E., Hallberg, C., Kathrein, M., & Cox, R.
(1972). Nursing grand rounds: Congestive failure.
Levine, M. E. (1972). Benoni. American Journal of Nursing Nursing ‘72, 2(10), 18–23.
72,(3), 466–468.
Levine, M. E., Line, L., Boyle, A., & Kopacewski, E. (1972).
Levine, M. E. (1972). Nursing educators—An alienating Nursing grand rounds: Insulin reactions in a brittle
elite? Chart, 69(2), 56–61. diabetic. Nursing ‘72, 2(5), 6–11.

Levine, M. E. (1973). On creativity in nursing. Image: The Levine, M. E., Moschel, P., Taylor, J., & Ferguson, G.
Journal of Nursing Scholarship, 3(3), 15–19. (1972). Nursing grand rounds: Complicated case of
CVA. Nursing ‘72, 2(3), 3–34.
Levine, M. E. (1974). The pharmacist’s clinical role in inter-
disciplinary care: A nurse’s viewpoint. Hospital Formulary Levine, M. E., Scanlon, M., Gregor, P., King, R., & Martin, N.
Management, 9, 47. (1972). Issues in rehabilitation: The quadriplegic adoles-
cent. Nursing ‘72, 2, 6.
Levine, M. E. (1975). On creativity in nursing. Nursing Digest,
3, 38–40. Levine, M. E., Zoellner, J., Ozmon, B., & Simunek, E.
(1972). Nursing grand rounds: Severe trauma. Nursing
Levine, M. E. (1977). Nursing ethics and the ethical nurse. ‘72, 2(9); 33–38.
American Journal of Nursing, 77, 845–849.
Secondary Sources
Levine, M. E. (1978). Cancer chemotherapy: A nursing Book Reviews
model. Nursing Clinics of North America, 13(2), [Review of Introduction to clinical nursing]. (1969, Sept/
271–280.
Oct.). Bedside Nurse, 2, 4.
Levine, M. E. (1978). Does continuing education improve [Review of Introduction to clinical nursing]. (1970, Feb.).
nursing practice? Hospitals, 52(21), 138–140.
Nursing Outlook, 18, 20.
Levine, M. E. (1978). Kapklavoo and nursing, too (Editorial). [Review of Introduction to clinical nursing]. (1970, Jan.).
Research in Nursing and Health, 1(2), 51.
American Journal of Nursing, 70, 99.
Levine, M. E. (1979). Knowledge base required by general- [Review of Introduction to clinical nursing]. (1970, Oct.).
ized and specialized nursing practice. ANA Publications,
(G-127), 57–69. American Journal of Nursing, 70, 2220.
[Review of Introduction to clinical nursing]. (1971, April).
Levine, M. E. (1980). The ethics of computer technology in
health care. Nursing Forum, 19(2), 193–198. Nursing Mirror, 132, 43.
[Review of Introduction to clinical nursing]. (1971, Dec.).
Levine, M. E. (1982). Bioethics of cancer nursing. Rehabili-
tation Nursing, 7, 27–31, 41. Nursing Mirror, 133, 16.

218 UNIT III  Nursing Conceptual Models Taylor, J. W. (1989). Levine’s conservation principles: Using
the model for nursing diagnosis in a neurological set-
[Review of Introduction to clinical nursing]. (1974, Feb.). ting. In J. P. Riehl-Sisca (Ed.), Conceptual models for
American Journal of Nursing, 74, 347. nursing practice (3rd ed., pp. 349–358). Norwalk, (CT):
Appleton & Lange.
[Review of Introduction to clinical nursing]. (1974, May).
Nursing Outlook, 22, 301. Journal Articles
Ballard, N., Robley, L., Barrett, D., Fraser, D., & Mendoza, I.
[Review of Introduction to clinical nursing]. (1971, Nov.).
Bedside Nurse, 4, 2. (2006). Patients’ recollections of therapeutic paralysis
in the intensive care unit. American Journal of Critical
[Review of Renewal for nursing]. (1971, Aug.). Supervisor Care,15(1), 86–94.
Nurse, 2, 68. Brunner, M. (1985). A conceptual approach to critical care
nursing using Levine’s model. Focus on Critical Care,
[Review of Renewal for nursing]. (1971, Dec.). AANA Journal, 12(2), 39–40.
49, 495. Cooper, D. M. (1990). Optimizing wound healing: A prac-
tice within nursing’s domain. Nursing Clinics of North
[Review of Renewal for nursing]. (1971, Dec.). Nursing America, 25(1), 165–180.
Mirror, 133, 16. Crawford-Gamble, P. E. (1986). An application of
Levine’s conceptual model. Perioperative Nursing
Book Chapters Quarterly, 2(1), 64–70.
Leonard, M. K. (1990). Myra Estrin Levine. In J. B. George Fawcett, J., Brophy, S. F., Rather, M. L., & Roos, J. (1997).
Commentary about Levine’s on creativity in nursing.
(Ed.), Nursing theories: The base for professional nursing Image: The Journal of Nursing Scholarship, 29(3),
practice (pp. 181–192). Englewood Cliffs, (NJ): Prentice 218–219.
Hall. Fawcett, J., Tulman, L., & Samarel, N. (1995). Enhancing
Meleis, A. I. (1985). Myra Levine. In A. I. Meleis (Ed.), The- function in life transitions and serious illness. Advanced
oretical nursing: Development and progress (pp. 275–283). Practice Nursing Quarterly, 1, 50–57.
Philadelphia: Lippincott. Falk, K., Swedberg, K., Gaston-Johansson, F., & Ekman, I.
Peiper, B. A. (1983). Levine’s nursing model. In J. J. Fitz- (2007). Fatigue is a prevalent and severe symptom as-
patrick & A. L. Whall (Eds.), Conceptual models of sociated with uncertainty and sense of coherence in
nursing: Analysis and application (pp. 101–115). Bowie, patients with chronic heart failure. European Journal of
(MD): Robert J. Brady. Cardiovascular Nursing, 6, 99–104.
Pond, J. B. (1990). Application of Levine’s Conservation Foreman, M. D. (1989). Confusion in the hospitalized el-
Model to nursing the homeless community. In M. E. derly: Incidence, onset, and associated factors. Research
Parker (Ed.), Nursing theories in practice (pp. 203–215). in Nursing and Health, 12(1), 21–29.
New York: National League for Nursing. Gagner-Tjellesen, D., Yurkovich, E. E., & Gragert, M.
Schaefer, K. M. (1990). A description of fatigue associated (2001). Use of music therapy and other ITNIs in acute
with congestive heart failure: Use of Levine’s Conserva- care. Journal of Psychosocial Nursing and Mental Health
tion Model. In M. E. Parker (Ed.), Nursing theories in Services, 39(10), 26–37.
practice (pp. 217–237). New York: National League for Hall, K. V. (1979). Current trends in the use of conceptual
Nursing. frameworks in nursing education. Journal of Nursing
Schaefer, K. M. (1996). Levine’s Conservation Model: Car- Education, 18(4), 26–29.
ing for women with chronic illness. In P. H. Walker & Happ, M. B., Williams, C. C., Strumpf, N. E., & Burger,
B. Neuman (Eds.), Blueprint for use of nursing models: S. G. (1996). Individualized care for frail elderly: The-
Education, research, practice and administration ory and practice. Journal of Gerontological Nursing,
(pp. 187–228). New York: National League for 22(3), 6–14.
Nursing Press. Hirschfeld, M. J. (1976). The cognitively impaired older
Schaefer, K. M. (2001). Levine’s Conservation Model: A adult. American Journal of Nursing, 76, 1981–1984.
model for the future of nursing. In Parker, M. E. (Ed.), Jost, S. G. (2000). An assessment and intervention strategy
Nursing theories and nursing practice (pp. 103–124). for managing staff needs during change. Journal of
Philadelphia: F. A. Davis. Nursing Administration, 30(1), 34–40.
Schaefer, K. M. (2001). Levine’s Conservation Model: Use Langer, V. S. (1990). Minimal handling protocol for the
of the model in nursing practice. In M. R. Alligood & intensive care nursery. Neonatal Network, 9(3), 23–27.
A. Marriner-Tomey (Eds.), Nursing theory: Utilization
& application (Taiwanese ed.; pp. 89–108). St. Louis:
Mosby.
Schaefer, K. M. (2002). Levine’s Conservation Model in
nursing practice. In M. R. Alligood & A. M. Tomey
(Eds.), Nursing theory: Utilization & application
(2nd ed., pp. 197–217). St. Louis: Mosby.

Lynn-McHale, D. J., & Smith, A. (1991). Comprehensive CHAPTER 12  Myra Estrin Levine 219
assessment of families of the critically ill. AACN Clinical Savage, T. V., & Culbert, C. (1989). Early intervention: The
Issues in Critical Care Nursing, 2(2), 195–209.
unique role of nursing. Journal of Pediatric Nursing,
Moch, V., St. Ours, C., Hall, S., Bositis, A., Tillery, M., Belcher, 4(5), 339–345.
A., et al. (2007). Using a conceptual model in nursing Schaefer, K. M. (1997). Levine’s Conservation Model in
research—mitigating fatigue in cancer patients. Journal nursing practice. In M. R. Alligood & A. Marriner
of Advanced Nursing, 58(5), 503–512. Tomey (Eds.), Nursing theory: Utilization & application
(pp. 89–107). St. Louis: Mosby.
Molchany, C. B. (1992). Ventricular septal and free wall Schaefer, K. M., & Pond, J. (1994). Levine’s Conservation
rupture complicating acute MI. Journal of Cardiovascular Model as a guide to nursing practice. Nursing Science
Nursing, 6(4), 38–45. Quarterly, 7(2), 53–54.
Schaefer, K. M., & Shober-Potylycki, M. J. (1993). Fatigue
Newport, M. A. (1984). Conserving thermal energy and in congestive heart failure: Use of Levine’s Conserva-
social integrity in the newborn. Western Journal of tion Model. Journal of Advanced Nursing, 18, 260–268.
Nursing Research, 6(2), 175–197. Schaefer, K. M., Swavely, D., Rothenberger, C., Hess, S.,
& Willistin, D. (1996). Sleep disturbances post coro-
O’Laughlin, K. M. (1986). Change in bladder function in nary artery bypass surgery. Progress in Cardiovascular
the woman undergoing radical hysterectomy for cervical Nursing, 11(1), 5–14.
cancer. Journal of Obstetrical, Gynecological and Neonatal Stafford, M. J. (1996). In tribute: Myra Estrin Levine, Pro-
Nursing, 15(5), 380–385. fessor Emerita, MSN, RN, FAAN. Chart, 93(3), 5–6.
Tompkins, E. S. (1980). Effect of restricted mobility and
Piccoli, M., & Galvao, C. M. (2001). Perioperative nurs- dominance on perceived duration. Nursing Research,
ing: Identification of the nursing diagnosis infection 29(6), 333–338.
risk based on Levine’s conceptual model (English Tribotti, S. (1990). Admission to the neonatal intensive
abstract). Revista Latino-Americana de Enfermagem, care unit: Reducing the risks. Neonatal Network, 8(4),
9(4), 37–43. 17–22.
Webb, H. (1993). Holistic care following a palliative
Roberts, K. L., Brittin, M., Cook, M., & deClifford, J. Hartmann’s procedure. British Journal of Nursing,
(1994). Boomerang pillows and respiratory capacity. 2(2), 128–132.
Clinical Nursing Research, 3(2), 157–165.

Roberts, K. L., Brittin, M., & deClifford, J. (1995). Boomer-
ang pillows and respiratory capacity in frail elderly
women. Clinical Nursing Research, 4(4), 465–471.

13C H A P T E R

Martha E. Rogers

1914 to 1994

Unitary Human Beings

Mary E. Gunther

“Professional practice in nursing seeks to promote symphonic interaction between man and environ-
ment, to strengthen the coherence and integrity of the human field, and to direct and redirect pat-
terning of the human and environmental fields for realization of maximum health potential”

(Rogers, 1970, p. 122).

Credentials and Background of the included an MA degree in public health nursing
Theorist supervision from Teachers College, Columbia Uni-
versity, New York (1945), and an MPH (1952) and
Martha Elizabeth Rogers, the eldest of four children an ScD (1954) from Johns Hopkins University in
of Bruce Taylor Rogers and Lucy Mulholland Keener Baltimore.
Rogers, was born May 12, 1914, in Dallas, Texas.
Soon after her birth, her family returned to Knoxville, Rogers’ early nursing practice was in rural public
Tennessee. She began her college education (1931 to health nursing in Michigan and in visiting nurse
1933) studying science at the University of Tennessee. supervision, education, and practice in Connecticut.
Receiving her nursing diploma from Knoxville Gen- Rogers subsequently established the Visiting Nurse
eral Hospital School of Nursing (1936), she quickly Service of Phoenix, Arizona. For 21 years (from 1954
obtained a BS degree from George Peabody College to 1975), she was professor and head of the Division
in Nashville, Tennessee (1937). Her other degrees of Nursing at New York University. After 1975, she
continued her duties as professor until she became

Photo credit: Kathleen Leininger, Shiner, TX.
Previous authors: Kaye Bultemeier, Mary Gunther, Joann Sebastian Daily, Judy Sporleder Maupin, Cathy A. Murray, Martha Carole
Satterly, Denise L. Schnell, and Therese L. Wallace. Earlier editions of this chapter were critiqued by Dr. Lois Meier and Dr. Martha
Rogers.
220

Professor Emerita in 1979. She held this title until her CHAPTER 13  Martha E. Rogers 221
death on March 13, 1994, at 79 years of age. humorous, blunt, and ethical. Rogers remains a widely
recognized scholar honored for her contributions and
Rogers’ publications include three books and more leadership in nursing. Butcher (1999) noted, “Rogers,
than 200 articles. She lectured in 46 states, the District like Nightingale, was extremely independent, a deter-
of Columbia, Puerto Rico, Mexico, the Netherlands, mined, perfectionist individual who trusted her vision
China, Newfoundland, Columbia, Brazil, and other despite skepticism” (p. 114). Colleagues consider her
countries (M. Rogers, personal communication, March one of the most original thinkers in nursing as she syn-
1988). Rogers received honorary doctorates from such thesized and resynthesized knowledge into “an entirely
renowned institutions as Duquesne University, Univer- new system of thought” (Butcher, 1999, p. 111). Today
sity of San Diego, Iona College, Fairfield University, she is thought of as “ahead of her time, in and out of this
Emory University, Adelphi University, Mercy College, world” (Ireland, 2000, p. 59).
and Washburn University of Topeka. The numerous
awards for her contributions and leadership in nursing Theoretical Sources
include citations for Inspiring Leadership in the Field of
Intergroup Relations by Chi Eta Phi Sorority, In Recog- Rogers’ grounding in the liberal arts and sciences
nition of Your Outstanding Contribution to Nursing by is apparent in both the origin and the development
New York University, and For Distinguished Service to of her conceptual model, published in 1970 as An
Nursing by Teachers College. In addition, New York Introduction to the Theoretical Basis of Nursing (Rogers,
University houses the Martha E. Rogers Center for the 1970). Aware of the interrelatedness of knowledge,
Study of Nursing Science. In 1996, Rogers was inducted Rogers credited scientists from multiple disciplines
posthumously into the American Nurses Association with influencing the development of the Science of
Hall of Fame. Unitary Human Beings. Rogerian science emerged
from the knowledge bases of anthropology, psychol-
In 1988, colleagues and students joined her in ogy, sociology, astronomy, religion, philosophy, history,
forming the Society of Rogerian Scholars (SRS) and biology, physics, mathematics, and literature to create a
immediately began to publish Rogerian Nursing Sci- model of unitary human beings and the environment
ence News, a members’ newsletter, to disseminate the- as energy fields integral to the life process. Within
ory developments and research studies (Malinski nursing, the origins of Rogerian science can be traced
2009). In 1993, the SRS began to publish a refereed to Nightingale’s proposals and statistical data, placing
journal, Visions: The Journal of Rogerian Nursing Sci- the human being within the framework of the natural
ence. The society includes a foundation that maintains world. This “foundation for the scope of modern nurs-
and administers the Martha E. Rogers Fund. In 1995, ing” began nursing’s investigation of the relationship
New York University established the Martha E. Rogers between human beings and the environment (Rogers,
Center to provide a structure for continuation of Ro- 1970, p. 30). Newman (1997) describes the Science of
gerian research and practice. Unitary Human Beings as “the study of the moving,
intuitive experience of nurses in mutual process with
A verbal portrait of Rogers includes such descriptive those they serve” (p. 9).
terms as stimulating, challenging, controversial, idealistic,
visionary, prophetic, philosophical, academic, outspoken,

MAJOR CONCEPTS & DEFINITIONS Rogers postulates that human beings are dynamic
In 1970, Rogers’ conceptual model of nursing rested energy fields that are integral with environmental
on a set of basic assumptions that described the fields. Both human and environmental fields are
life process in human beings. Wholeness, openness, identified by pattern and characterized by a universe
unidirectionality, pattern and organization, sen- of open systems. In her 1983 paradigm, Rogers pos-
tience, and thought characterized the life process tulated four building blocks for her model: energy
(Rogers, 1970).
Continued

222 UNIT III  Nursing Conceptual Models

MAJOR CONCEPTS & DEFINITIONS—cont’d

field, a universe of open systems, pattern,and four- human and environmental fields change continu-
dimensionality. ously, creatively, and integrally (Rogers, 1994a).

Rogers consistently updated the conceptual model Universe of Open Systems
through revision of the homeodynamic principles. The concept of the universe of open systems holds
Such changes corresponded with scientific and tech- that energy fields are infinite, open, and integral
nological advances. In 1983, Rogers changed her with one another (Rogers, 1983). The human and
wording from that of unitary man to unitary human environmental fields are in continuous process and
being, to remove the concept of gender. Additional are open systems.
clarification of unitary human beings as separate
and different from the term holistic stressed the Pattern
unique contribution of nursing to health care. In Pattern identifies energy fields. It is the distinguishing
1992, four-dimensionality evolved into pandimension- characteristic of an energy field and is perceived as a
ality. Rogers’ fundamental postulates have remained single wave. The nature of the pattern changes con-
consistent since their introduction; her subsequent tinuously and innovatively, and these changes give
writings served to clarify her original ideas. identity to the energy field. Each human field pattern
is unique and is integral with the environmental field
Energy Field (Rogers, 1983). Manifestations emerge as a human-
An energy field constitutes the fundamental unit of environmental mutual process. Pattern is an abstrac-
both the living and the nonliving. Field is a unifying tion; it reveals itself through manifestation. A sense
concept, and energy signifies the dynamic nature of of self is a field manifestation, the nature of which is
the field. Energy fields are infinite and pandimen- unique to each individual. Some variations in pat-
sional. Two fields are identified: the human field and tern manifestations have been described in phrases
the environmental field. “Specifically human beings such as “longer versus shorter rhythms,” “pragmatic
and environment are energy fields” (Rogers, 1986b, versus imaginative,” and time experienced as “fast”
p. 2). The unitary human being (human field) is or “slow.” Pattern is changing continually and may
defined as an irreducible, indivisible, pandimen- manifest disease, illness, or well-being. Pattern change
sional energy field identified by pattern and mani- is continuous, innovative, and relative.
festing characteristics that are specific to the whole
and that cannot be predicted from knowledge of Pandimensionality
the parts. The environmental field is defined as Rogers defines pandimensionality as a nonlinear
an irreducible, pandimensional energy field identi- domain without spatial or temporal attributes, or as
fied by pattern and integral with the human field. Phillips (2010) notes: “essentially a spaceless and
Each environmental field is specific to its given timeless reality” (p. 56). The term pandimensional
human field. While not necessarily quantifiable, provides for an infinite domain without limit. It best
an energy field has the inherent ability to create expresses the idea of a unitary whole.
change (Todaro-Franceschi, 2008). In this case, both

Use of Empirical Evidence apparent of these are the nonlinear dynamics of quan-
tum physics and general system theory.
Being an abstract conceptual system, the Science
of Unitary Human Beings does not directly identify Evident in her model are the influence of Einstein’s
testable empirical indicators. Rather, it specifies a (1961) theory of relativity in relation to space-time
worldview and philosophy used to identify the phe- and Burr and Northrop’s (1935) electrodynamic the-
nomena of concern to the discipline of nursing. As ory relating to electrical fields. By the time von
was mentioned previously, Rogers’ model emerged Bertalanffy (1960) introduced the general system
from multiple knowledge sources; the most readily theory, theories regarding a universe of open systems

were beginning to affect the development of knowl- CHAPTER 13  Martha E. Rogers 223
edge within all disciplines. With the general system
theory, the term negentropy was brought into use Nursing exists for the care of people and the life
to signify increasing order, complexity, and heteroge- process of humans.
neity in direct contrast to the previously held belief Person
that the universe was winding down. Rogers, how- Rogers defines person as an open system in continuous
ever, refined and purified the general system theory process with the open system that is the environment
by denying hierarchical subsystems, the concept of (integrality). She defines unitary human being as an
single causation, and the predictability of a system’s “irreducible, indivisible, pandimensional energy field
behavior through investigations of its parts. identified by pattern and manifesting characteristics
that are specific to the whole” (Rogers, 1992, p. 29).
Introducing quantum theory and the theories of Human beings “are not disembodied entities, nor are
relativity and of probability fundamentally challenged they mechanical aggregates. . . . Man is a unified
the prevailing absolutism. As new knowledge escalated, whole possessing his own integrity and manifesting
the traditional meanings of homeostasis, steady state, characteristics that are more than and different from
adaptation,and equilibrium were questioned seriously. the sum of his parts” (Rogers, 1970, pp. 46–47).
The closed-system, entropic model of the universe was Within a conceptual model specific to nursing’s con-
no longer adequate to explain phenomena, and evi- cern, people and their environment are perceived as
dence accumulated in support of a universe of open irreducible energy fields integral with one another and
systems (Rogers, 1994b). Continuing development continuously creative in their evolution.
within other disciplines of the acausal, nonlinear dy- Health
namics of life validated Rogers’ model. Most notable Rogers uses the term health in many of her earlier
of this development is that of chaos theory, quantum writings without clearly defining the term. She uses
physics’ contribution to the science of complexity (or the term passive health to symbolize wellness and the
wholeness), which blurs the boundaries between the absence of disease and major illness (Rogers, 1970).
disciplines, allowing exploration and deepening of the Her promotion of positive health connotes direction
understanding of the totality of human experience. in helping people with opportunities for rhythmic
consistency (Rogers, 1970). Later, she wrote that well-
Major Assumptions ness “is a much better term . . . because the term
Nursing health is very ambiguous” (Rogers, 1994b, p. 34).

Nursing is a learned profession and is both a science Rogers uses health as a value term defined by the
and an art. It is an empirical science and, like other culture or the individual. Health and illness are mani-
sciences, it lies in the phenomenon central to its festations of pattern and are considered “to denote
focus. Rogerian nursing focuses on concern with behaviors that are of high value and low value” (Rogers,
people and the world in which they live—a natural fit 1980). Events manifested in the life process indicate the
for nursing care, as it encompasses people and their extent to which a human being achieves maximum
environments. The integrality of people and their health according to some value system. In Rogerian
environments, operating from a pandimensional uni- science, the phenomenon central to nursing’s concep-
verse of open systems, points to a new paradigm and tual system is the human life process. The life process
initiates the identity of nursing as a science. The pur- has its own dynamic and creative unity that is insepa-
pose of nursing is to promote health and well-being rable from the environment and is characterized by
for all persons. The art of nursing is the creative use of the whole (Rogers, 1970). Using this definition as a
the science of nursing for human betterment (Rogers, foundation for their research, Gueldner, and colleagues
1994b). “Professional practice in nursing seeks to (2005) postulate that a human being’s sense of well-
promote symphonic interaction between human and being (wellness) manifests itself by higher frequency
environmental fields, to strengthen the integrity of and increasing pattern diversity.
the human field, and to direct and redirect patterning
of the human and environmental fields for realization In “Dimensions of Health: A View from Space,”
of maximum health potential” (Rogers, 1970, p. 122). Rogers (1986b) reaffirms the original theoretical asser-
tions, adding philosophical challenges to the prevailing

224 UNIT III  Nursing Conceptual Models of the parts. Each environmental field is specific to its
given human field. Both change continuously and cre-
perception of health. Stressing a new worldview that atively” (p. 3). Environmental fields are infinite, and
focuses on people and their environment, she lists change is continuously innovative, unpredictable, and
iatrogenesis, nosocomial conditions, and hypochron- characterized by increasing diversity. Environmental
driasis as the major health problems in the United and human fields are identified by wave patterns
States. Rogers (1986b) writes, “A new world view com- manifesting continuous mutual change.
patible with the most progressive knowledge available
is a necessary prelude to studying human health and Theoretical Assertions
to determining modalities for its promotion whether
on this planet or in the outer reaches of space” (p. 2). The principles of homeodynamics postulate a way
Environment of perceiving unitary human beings. The evolution
Rogers (1994a) defines environment as “an irreduc- of these principles from 1970 to 1994 is depicted in
ible, pandimensional energy field identified by pattern Table 13–1. Rogers (1970) wrote, “The life process is
and manifesting characteristics different from those

TABLE 13-1  Evolution of Principles of Homeodynamics: 1970, 1983, 1986, and 1992

An Introduction to Nursing: A Science Science of Unitary Human Dimensions of Nursing Science
the Theoretical Basis of Unitary Man, 1980 Beings: A Paradigm for Health: A View and the Space Age,
of Nursing, 1970 Nursing, 1983 From Space, 1986 1992
Continuous change
Resonancy from lower- to higher- Continuous change from Continuous change Continuous change
Continuously propa- frequency wave lower- to higher-frequency from lower- to from lower- to
patterns in the human wave patterns in the higher-frequency higher-frequency
gating series of and environmental human and environmental wave patterns in wave patterns in
waves between fields fields the human and the human and
man and environ- environmental fields environmental fields
ment Nature of change be- Continuous innovative,
tween human and probabilistic, increasing Continuous, innova- Continuous, innova-
Helicy environmental fields diversity of human and tive, probabilistic, tive, unpredictable,
Continuous, innova- is continuously innova- environmental field increasing, and increasing diversity
tive, probabilistic, and patterns, characterized environmental of human and
tive change growing increasingly diverse, by nonrepeating diversity character- environmental
out of mutual inter- manifesting nonre- rhythmicities ized by nonrepeating field patterns
action of man and peating rhythmicities rhythmicities
environment along a — —
spiraling longitudinal — —
axis bound in Continuous, mutual Continuous, mutual
space-time Continuous, mutual, human field and Continuous, mutual human field and
simultaneous interac- environmental field human field and environmental field
Reciprocy tion between human process environmental field process
Continuous mutual and environmental process
fields
interaction between
the human and
environmental fields

Synchrony
Change in the human

field and simultane-
ous state of envi-
ronmental field
at any given point
in space-time

Conceptualized by J. S. Daily; revised by D. Schnell & T. Wallace; updated by C. Murray.

homeodynamic. . . . these principles postulate the CHAPTER 13  Martha E. Rogers 225
way the life process is and predict the nature of its
evolving” (p. 96). Rogers identified the principles of Rogers explains nursing by referring to broader
change as helicy, resonancy, and integrality. The helicy principles that explain human beings. She explains
principle describes spiral development in continuous, human beings through principles that characterize
nonrepeating, and innovative patterning. Rogers’ the universe, based on the perspective of a whole
articulation of the principle of helicy describing the that organizes the parts.
nature of change evolved from probabilistic to unpre-
dictable, while remaining continuous and innovative. Rogers’ model of unitary human beings is deductive
According to the principle of resonancy, patterning and logical. The theory of relativity, the general system
changes with the development from lower to higher theory, the electrodynamic theory of life, and many
frequency, that is, with varying degrees of intensity. other theories contributed ideas for Rogers’ model.
Resonancy embodies wave frequency and energy field Unitary human beings and environment, the central
pattern evolution. Integrality, the third principle components of the model, are integral with one
of homeodynamics, stresses the continuous mutual another. The basic building blocks of her model are
process of person and environment. The principles of energy field, openness, pattern, and pandimensionality
homeodynamics (nature, process, and context of providing a new worldview. These concepts form the
change) support and exemplify the assertion that “the basis of an abstract conceptual system defining nursing
universe is energy that is always becoming more and health. From the abstract conceptual system,
diverse through changing, continuous wave frequen- Rogers derived the principles of homeodynamics,
cies” (Phillips, 2010, p. 57). In addition, Todaro- which postulate the nature and direction of human
Franceschi (2008) reminds us that this changing beings’ evolution. Although Rogers invented the
nature is intrinsic to, not outside of, fields. words homeodynamics (similar state of change and
growth), helicy (evolution), resonancy (intensity of
In 1970, Rogers identified the following five assump- change), and integrality (wholeness), all definitions
tions that are also theoretical assertions supporting are etymologically consistent and logical.
her model derived from literature on human beings,
physics, mathematics, and behavioral science: Acceptance by the Nursing Community
1. “Man is a unified whole possessing his own integ- Practice

rity and manifesting characteristics more than The Rogerian model is an abstract system of ideas
and different from the sum of his parts” (energy from which to approach the practice of nursing.
field) (p. 47). Rogers’ model, stressing the totality of experience
2 . “Man and environment are continuously exchang- and existence, is relevant in today’s health care sys-
ing matter and energy with one another” (open- tem, where a continuum of care is more important
ness) (p. 54). than episodic illness and hospitalization. This model
3. “The life process evolves irreversibly and unidirec- provides the abstract philosophical framework from
tionally along the space-time continuum” (helicy) which to view the unitary human-environmental
(p. 59). field phenomenon. Within the Rogerian framework,
4. “Pattern and organization identify man and reflect nursing is based on theoretical knowledge that
his innovative wholeness” (pattern and organiza- guides nursing practice. The professional practice of
tion) (p. 65). nursing is creative and imaginative and exists to
5. “Man is characterized by the capacity for abstrac- serve people. It is rooted in intellectual judgment,
tion and imagery, language and thought, sensation, abstract knowledge, and human compassion.
and emotion” (sentient, thinking being) (p. 73).
Historically, nursing has equated practice with
Logical Form the practical and theory with the impractical. More
appropriately, theory and practice are two related
Rogers uses a dialectic method as opposed to a logis- components in a unified nursing practice. Alligood
tical, problematic, or operational method, that is, (1994) articulates how theory and practice direct and
guide each other as they expand and increase unitary
nursing knowledge. Nursing knowledge provides the

226 UNIT III  Nursing Conceptual Models The Rogerian model provides a challenging and
framework for the emergent artistic application of innovative framework from which to plan and imple-
nursing care (Rogers, 1970). ment nursing practice, which Barrett (1998) defines
as the “continuous process (of voluntary mutual pat-
Within Rogers’ model, the critical thinking pro- terning) whereby the nurse assists clients to freely
cess directing practice can be divided into three choose with awareness ways to participate in their
components: pattern appraisal, mutual patterning, well-being” (p. 136).
and evaluation. Cowling (2000) states that pattern
appraisal is meant to avoid, if not transcend, reduc- Education
tionistic categories of physical, mental, spiritual, Rogers clearly articulated guidelines for the education
emotional, cultural, and social assessment frame- of nurses within the Science of Unitary Human Beings.
works. Through observation and participation, the Rogers discusses structuring nursing education pro-
nurse focuses on human expressions of reflection, grams to teach nursing as a science and as a learned
experience, and perception to form a profile of the profession. Barrett (1990b) calls Rogers a “consistent
patient. Mutual exploration of emergent patterns voice crying out against antieducationalism and de-
allows identification of unitary themes predominant pendency” (p. 306). Rogers’ model clearly articulates
in the pandimensional human-environmental field values and beliefs about human beings, health, nursing,
process. Mutual understanding implies knowing par- and the educational process. As such, it has been
ticipation but does not lead to the nurse’s prescribing used to guide curriculum development in all levels of
change or predicting outcomes. As Cowling (2000) nursing education (Barrett, 1990b; DeSimone, 2006;
explains, “A critical feature of the unitary pattern Hellwig & Ferrante, 1993; Mathwig, Young, & Pepper,
appreciation process, and also of healing through 1990). Rogers (1990) stated that nurses must commit
appreciating wholeness, is a willingness on the part to lifelong learning and noted, “The nature of the prac-
of the scientist or practitioner to let go of expecta- tice of nursing (is) the use of knowledge for human
tions about change” (p. 31). Evaluation centers on the betterment” (p. 111).
perceptions emerging during mutual patterning.
Rogers advocated separate licensure for nurses
Noninvasive patterning modalities used within prepared with an associate’s degree and those with a
Rogerian practice include, but are not limited to, baccalaureate degree, recognizing that there is a dif-
acupuncture, aromatherapy, touch and massage, ference between the technically oriented and the
guided imagery, meditation, self-reflection, guided professional nurse. In her view, the professional nurse
reminiscence, humor, hypnosis, dietary manipula- must be well rounded and educated in the humani-
tion, transcendent presence, and music (Alligood, ties, sciences, and nursing. Such a program would
1991a; Jonas-Simpson, 2010; Larkin, 2007; Levin, include a basic education in language, mathematics,
2006; Lewandowski, et al., 2005; Malinski & logic, philosophy, psychology, sociology, music, art,
Todaro-Franceschi, 2011; Siedliecki & Good, 2006; biology, microbiology, physics, and chemistry; elec-
Smith, Kemp, Hemphill, & Vojir, 2002; Smith & Kyle, tive courses could include economics, ethics, political
2008; Walling, 2006; Yarcheski, Mahon, & Yarcheski, science, anthropology, and computer science (Barrett,
2002). Barrett (1998) notes that integral to these mo- 1990b). With regard to the research component of the
dalities are “meaningful dialogue, centering, and curriculum, Rogers (1994b) stated the following:
pandimensional authenticity (genuineness, trustwor-
thiness, acceptance, and knowledgeable caring)” Undergraduate students need to be able to identify
(p. 138). Nurses participate in the lived experience of problems, to have tools of investigation and to do
health in a multitude of roles, including “facilitators studies that will allow them to use knowledge for
and educators, advocates, assessors, planners, coor- the improvement of practice, and they should
dinators, and collaborators,” by accepting diversity, be able to read the literature intelligently. People
recognizing patterns, viewing change as positive, and with master’s degrees ought to be able to do
accepting the connectedness of life (Malinski, 1986, applied research. . . . The theoretical research, the
p. 27) These roles may require the nurse to “let go fundamental basic research is going to come out of
of traditional ideas of time, space, and outcome”
(Malinski, 1997, p. 115).

CHAPTER 13  Martha E. Rogers 227

doctoral programs of stature that focus on nursing Principles of Homeodynamics
as a learned field of endeavor (p. 34).
Resonancy Helicy Integrality
Barrett (1990b) notes that with increasing use of
technology and increasing severity of illness of hospi- Midrange theories
talized patients, students may be limited to observa-
tional experiences in these institutions. Therefore, the Bultemeier Barrett Floyd
acquisition of manipulative technical skills must be (1993) (1990a) (1983)
accomplished in practice laboratories and at alterna-
tive sites, such as clinics and home health agencies. FIGURE 13-1  ​Theory development within the Science of
Other sites for education include health promotion Unitary Human Beings.
programs, managed care programs, homeless shelters,
and senior centers. her overview of Rogerian science–based theories,
Malinski (2009) identifies work within specific concepts:
Research (1) self-transcendence (Reed, 2003), enlightenment
Rogers’ conceptual model provides a stimulus and (Hills & Hanchett, 2001), and spirituality (Malinski,
direction for research and theory development in 1994; Smith, 1994); (2) turbulence (Butcher, 1993)
nursing science. Fawcett (2000), who insists that the and dissonance (Bultemeier, 2002); (3) aging (Alligood
level of abstraction affects direct empirical observation & McGuire, 2000; Butcher, 2003); (4) intentionality
and testing, endorses the designation of the Science of (Ugarizza, 2002; Zahourek, 2005); and (5) unitary
Unitary Human Beings as a conceptual model rather caring (Watson & Smith, 2002). Other middle-range
than a grand theory. She states clearly that the purpose theories encompass the phenomena of human field
of the work determines its category. Conceptual mod- motion (Ference, 1986), as well as creativity, actualiza-
els “identify the purpose and scope of nursing and tion, and empathy (Alligood, 1991b).
provide frameworks for objective records of the effects
of nursing” (Fawcett, 2005, p. 18). Rogers (1986a) maintains that research in nurs-
ing must examine unitary human beings as integral
Emerging from Rogers’ model are theories that ex- with their environment. Therefore, the intent of
plain human phenomena and direct nursing practice. nursing research is to examine and understand a
The Rogerian model, with its implicit assumptions, phenomenon and, from this understanding, design
provides broad principles that conceptually direct the- patterning activities that promote healing. To obtain
ory development. The conceptual model provides a a clearer understanding of lived experiences, the
stimulus and direction for scientific activity. Relation- person’s perception and sentient awareness of what
ships among identified phenomena generate both grand is occurring are imperative. The variety of events
(further development of one aspect of the model) and associated with human phenomena provides the
middle-range (description, explanation, or prediction experiential data for research that is directed toward
of concrete aspects) theories (Fawcett, 1995). capturing the dynamic, ever-changing life experi-
ences of human beings. Selecting the correct method
Two prominent grand nursing theories grounded for examining the person and the environment as
in Rogers’ model are Newman’s health as expanding health-related phenomena is the challenge of the
consciousness and Parse’s human becoming (Fawcett, Rogerian researcher. Both quantitative and qualita-
2005). Numerous middle-range theories have emerged tive approaches have been used in the Science
from Rogers’ three homeodynamic principles as fol- of Unitary Human Beings research, although not
lows: (1) helicy, (2) resonancy, and (3) integrality all researchers agree that both are appropriate.
(Figure 13–1). Exemplars of middle-range theories
derived from homeodynamic principles include
power-as-knowing-participation-in-change (helicy)
(Barrett, 2010), the theory of perceived dissonance
(resonancy) (Bultemeier, 2002), and the theory of
interactive rhythms (integrality) (Floyd, 1983). In

228 UNIT III  Nursing Conceptual Models respects the inherent interconnectedness of phenom-
Researchers do agree that ontological and epistemo- ena. A pattern profile is composed through a synopsis
logical congruence between the model and the and synthesis of the data (Barrett, Cowling, Carboni,
approach must be considered and reflected by et al., 1997). Other innovative methods of recording
the research question (Barrett, Cowling, Carboni, and entering the human-environmental field phenom-
& Butcher, 1997). Quantitative experimental and enon include photo-disclosure (Bultemeier, 1997),
quasi-experimental designs are not appropriate, be- descriptive phenomenology (Willis & Griffith, (2010),
cause their purpose is to reveal causal relationships. hermeneutic text interpretation (Alligood & Fawcett,
Descriptive, explanatory, and correlational designs 1999), and measurement of the effect of dialogue
are more appropriate, because they acknowledge combined with noninvasive modalities (Leddy &
diversity, universality, and patterned change. Fawcett, 1997).

Specific research methods emerging from middle- Rogerian instrument development is extensive
range theories based on the Rogerian model capture and ever-evolving. A wide range of instruments for
the human-environmental phenomena. As a means of measuring human-environmental field phenomena
capturing the unitary human being, Cowling (1998) have emerged (Table 13–2). The continual emergence
describes the process of pattern appreciation using the of middle-range theories, research approaches, and
combined research and practice case study method. instruments demonstrates recognition of the impor-
Case study attends to the whole person (irreducibil- tance of Rogerian science to nursing.
ity), aims at comprehending the essence (pattern), and

TABLE 13-2  R esearch Instruments and Practice Tools Derived From the Science of
Unitary Human Beings

Human Field Motion Test (HFMT) (Ference, 1986; Measures human field motion by means of semantic differential ratings of
the concepts My Motor Is Running and My Field Expansion.
Perceived Field Motion Scale (PFM) (Yarcheski &
Mahon, 1991) Measures the perceived experience of motion by means of semantic
differential ratings of the concept My Field Motion.
Human Field Rhythms (HFR) (Yarcheski &
Mahon, 1991) Measures the frequency of rhythms in the human-environmental energy
field mutual process by means of a one-item visual analogue scale.
The Well-being Picture Scale (Gueldner et al.,
2005) (Terwilliger, Gueldner, & Bronstein, 2012) A non–language-based pictorial scale that measures concepts of frequency,
awareness, action, and power of energy field (general well-being) in
Power as Knowing Participation in Change Tool adults. Evaluated in children in 2012.
(PKPCT) (Barrett, 1990a, 2010)
Measures the person’s capacity to participate knowingly in change by
Diversity of Human Field Pattern Scale (DHFPS) means of semantic differential ratings of the concepts Awareness,
(Hastings-Tolsma, 1993) Choices, Freedom to Act Intentionally, and Involvement in Creating
Changes.
Human Field Image Metaphor Scale (HFIMS)
(Johnston, 1993, 1994) Measures diversity of human field pattern, or degree of change in the evo-
lution of human potential throughout the life process, by means of Likert
Temporal Experience Scale (TES) (Paletta, 1990) scale ratings of 16 items.

Assessment of Dream Experience (ADE) Measures the individual’s awareness of the infinite wholeness of the
(Watson, 1999) human field by means of Likert scale ratings of 14 metaphors that
represent perceived potential and 11 metaphors that represent per-
ceived field integrality.

Measures subjective experience of temporal awareness by means of Likert
scale ratings of 24 metaphors representing the factors of time dragging,
time racing, and timelessness.

Measures dreaming as a beyond waking experience by means of Likert
scale ratings of the extent to which 20 items describe what the individual’s
dreams have been like during the past 2 weeks.

CHAPTER 13  Martha E. Rogers 229

TABLE 13-2  Research Instruments and Practice Tools Derived From the Science of
Unitary Human Beings—cont’d

Person-Environment Participation Scale (PEPS) Measures the person’s experience of continuous human-environment
(Leddy, 1995, 1999) mutual process by means of semantic differential ratings of 15 bipolar
adjectives representing the content areas of comfort, influence, continuity,
Leddy Heartiness Scale (LHS) (Leddy, 1996) ease, and energy.

McCanse Readiness for Death Instrument (MRDI) Measures the person’s perceived purpose and power to achieve goals by
(McCanse,1995) means of Likert scale ratings of 26 items representing meaningfulness,
ends, choice, challenge, confidence, control, capability to function, and
Mutual Exploration of the Healing Human- connections.
Environmental Field Relationship (Carboni, 1992)
Measures physiological, psychological, sociological, and spiritual aspects
Practice Tool and Citation of healthy field pattern, as death is developmentally approached by
Nursing Process Format (Falco & Lobo, 1995) means of a 26-item structured interview questionnaire.

Assessment Tool (Smith et al., 1991) Measures nurses’ and clients’ experiences and expressions of changing
configurations of energy field patterns of the healing human-environmental
Critical Thinking for Pattern Appraisal, Mutual field relationship using semi-structured and open-ended items. Forms
Patterning, and Evaluation Tool (Bultemeier, for a nurse and a single client and for a nurse and two or more clients
2002) are available.

Nursing Assessment of Patterns Indicative Description
of Health (Madrid & Winstead-Fry, 1986)
Guides use of a Rogerian nursing process, including nursing assessment,
Assessment Tool for Postpartum Mothers nursing diagnosis, nursing planning for implementation, and nursing
(Tettero et al., 1993) evaluation, according to the homeodynamic principles of integrality,
resonancy, and helicy.
Assessment Criteria for Nursing Evaluation of the
Older Adult (Decker, 1989) Guides use of a Rogerian nursing process, including assessment, diagno-
sis, implementation, and evaluation, according to the homeodynamic
Holistic Assessment of the Chronic Pain Client principles of complementarity (i.e., integrality), resonancy, and helicy,
(Garon, 1991) for patients hospitalized in a critical care unit and their family members,
using open-ended questions.

Provides guidance for the nurse’s application of pattern appraisal, mutual
patterning, and evaluation, as well as areas for the client’s self-reflection,
patterning activities, and personal appraisal.

Guides assessment of patterns, including relative present, communication,
sense of rhythm, connection to environment, personal myth, and system
integrity.

Guides assessment of mothers experiencing the challenges of their first
child during the postpartum period.

Guides assessment of the functional status of older adults living in their
own homes, including demographic data, client prioritization of problems,
sequential patterning (e.g., family of origin culture, past illnesses), rhyth-
mical patterning (e.g., health care usage, medication usage, social
contacts, acute illnesses), and cross-sectional patterning (e.g., current
living arrangements and health concerns, cognitive and emotional status).

Guides holistic assessment of clients living in their own homes and experi-
encing chronic pain, including the environmental field, the community, and
all systems in contact with the client; the home environment; client needs
and expectations; client and family strengths; the client’s pain experi-
ence—location, intensity, cause, meaning, effects on activities, life, and
relationships, relief measures, and goals; and client and family feelings
about illness and pain.

Continued

230 UNIT III  Nursing Conceptual Models

TABLE 13-2  Research Instruments and Practice Tools Derived From the Science of
Unitary Human Beings—cont’d

Human Energy Field Assessment Form Used to record findings related to human energy field assessment as
(Wright, 1991) practiced in therapeutic touch, including location of field disturbance
on a body diagram and strength of the overall field and intensity of the
field disturbance on visual analogue scales.

Family Assessment Tool (Whall, 1981) Guides assessment of families in terms of individual subsystem consider-
ations, interactional patterns, unique characteristics of the whole family
system, and environmental interface synchrony.

An Assessment Guideline for Work with Families Guides assessment of the family unit, in terms of definition of family,
(Johnston, 1986) family organization, belief system, family developmental needs, eco-
nomic factors, family field and environmental field complementarity,
communication patterns, and supplemental data, including health
assessment of individual family members, developmental factors,
member interactions, and relationships.

Nursing Process Format for Families (Reed, 1986) Guides the use of a developmentally oriented nursing process for families.

Community Health Assessment (Hanchett, 1988) Guides assessment of a community in areas of diversity; rhythms, including
frequencies of colors, rhythms of light, and patterns of sound; motion;
experience of time; pragmatic-imaginative-visionary worldviews; and
sleep-wake beyond waking rhythms.

Adapted from Fawcett, J. (2005). Contemporary nursing knowledge: Analysis and evaluation of nursing models and theories (pp. 337–339). Philadelphia:
F. A. Davis. Used with permission.

Further Development of operational definitions, and inadequate tools
for measurement (Butterfield, 1983). However, the
Rogers (1986a) believed that knowledge develop- model has passed the test of time for the development
ment within her model was a “never-ending process” of nursing science as nursing matured as a science.
using “a multiplicity of knowledge from many Rogers’ ideas continue to demonstrate clarity for
sources . . . to create a kaleidoscope of possibilities” nursing research with human beings of all ages
(p. 4). Explorations by Rogerian scholars into tran- (Terwilliger, Gueldner, & Bronstein, 2012).
scendence and universality exemplify this belief in
a unifying wholeness (Phillips, 2010). Simplicity
Ongoing studies and work within the model have
Fawcett (2005) identified the following three rudi- served to simplify and clarify some of the concepts and
mentary theories developed by Rogers from the Science relationships. However, when the model is examined in
of Unitary Human Beings: total perspective, some still classify it as complex. With
1 . Theory of accelerating evolution its continued use in practice, research, and education,
2 . Theory of rhythmical correlates of change nurses will come to appreciate the model’s elegant
3 . Theory of paranormal phenomena simplicity. As Whall (1987) noted, “With only three
principles, a few major concepts, and five assumptions,
Continued explication and testing of these theories Rogers has explained the nature of man and the life
and the homeodynamic principles by nurse researchers process” (p. 154).
contributes to nursing science knowledge.
Generality
Critique Rogers’ conceptual model is abstract and therefore gen-
Clarity eralizable and powerful. It is broad in scope, providing

There were early criticisms of the model with com-
ments such as difficult-to-understand principles, lack

a framework for the development of nursing knowledge CHAPTER 13  Martha E. Rogers 231
through the generation of grand and middle-range
theories. CASE STUDY
Accessibility Charlie Dee is a 56-year-old male client with a
Drawing on knowledge from a multitude of scientific 30-year history of smoking two packs of cigarettes
fields, Rogers’ conceptual model is deductive in logic per day. He is seeing nurse practitioner Sandra Gee
with an inherent lack of immediate empirical support for the first time after being diagnosed with chronic
(Barrett, 1990b). As Fawcett (1995) points out, failure to obstructive pulmonary disease. Pattern appraisal
properly categorize the work as a conceptual model begins with eliciting the client’s description of his
rather than as a theory leads to “considerable misunder- experience with this disease, his perceptions of his
standings and inappropriate expectations” (p. 29), health, and how the disease is expressed (symp-
which can result in the work being labeled inadequate. toms). Mr. Dee states that he has a productive
cough that is worse in the morning, gets short of
As noted earlier, the development of the model by breath whenever he is physically active, and always
Rogerian scientists has resulted in the generation of feels tired. Through specific questions, the nurse
testable theories accompanied by tools of measurement. practitioner discovers that Mr. Dee has experienced
Importance a change in his sleep patterns and nutritional intake.
Rogers’ science has the fundamental intent of under- He is sleeping for shorter periods and eating less.
standing human evolution and its potential for human She also learns that Mr. Dee’s wife smokes, and that
betterment. The science “coordinates a universe of they have indoor cats for pets. He does not think
open systems to identify the focus of a new paradigm that his wife will be amenable to changing her hab-
and initiate nursing’s identity as a science” (Rogers, its or getting rid of the cats. During this appraisal,
1989, p. 182). the nurse seeks to discover what is important to
Mr. Dee and how he defines healthy.
Although all the metaparadigm concepts are ex-
plored, the emphasis is on the integrality of human- Mutual patterning involves sharing knowledge
environmental field phenomena. Rogers suggested and offering choices. Upon completion of the ap-
many ideas for future studies; on the basis of this and praisal, the nurse summarizes what she has been
the research of others, it can be said that the concep- told and how she understands it. In this way, the
tual model is useful. Such utility has been proven nurse and the client can reach consensus about
in the arenas of practice, education, administration, what activities would be acceptable to Mr. Dee.
and research. Ms. Gee provides information about the disease
and suggestions that will increase his comfort. Non-
Summary invasive interventions include breathing retraining,
recommendations for a high-protein high-calorie
The Rogerian model emerged from a broad historical diet, eating smaller meals more frequently, sleeping
base and has moved to the forefront as scientific knowl- with the head elevated, and using progressive relax-
edge has evolved. Understanding the concepts and ation exercises at bedtime. The nurse recommends
principles of the Science of Unitary Human Beings that the Dees buy a HEPA filter and humidifier to
requires a foundation in general education, a willing- assist in removing environmental pollutants and
ness to let go of the traditional, and an ability to perceive maintaining proper humidity in the home.
the world in a new and creative way. Emerging from a
strong educational base, this model provides a challeng- Because Mr. Gee has expressed a desire to quit
ing framework from which to provide nursing care. The smoking, the nurse suggests that he use forms of
abstract ideas expounded in the Rogerian model and centering, such as guided imagery and meditation,
their congruence with modern scientific knowledge to supplement the nicotine patches prescribed by
spur new and challenging theories that further the his physician. She also provides him with written
understanding of the unitary human being. material about the disease that he can share with
his wife. At the end of the visit, Mr. Dee states that
he feels better knowing that he has the power to
change some things about his life.