Where Nursing’s Future Began

Here’s a review of our professional origins, to lend a bit of history that helps explain the disconnects between our education, our clinical practice demands and the way we feel about what is happening around us and within us.


Nightingale’s wisdom aside, nursing as a discipline was being pulled down the path of medicine in the last century.

In 1978, Barbara Carper wrote an article that described four fundamental areas of knowledge that provided the rationale for nursing practice based on observed patterns, forms and structures that were evident surrounding our practice.

These were:

  1. empirics, the science of nursing
  2. esthetics, the art of nursing
  3. personal, from self knowledge
  4. ethics, our moral knowledge

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The motivation for defining Nursing’s distinct sources of knowledge at that time was to put forth…

“… a holistic, individualistic, and therapeutic model of practice that took the profession away from the autocratic, reductionist and behaviorist characteristics of the medical model.”          Zander, p7

This was an effort to redirect our future by breaking away

from the medical model and “old school” nursing.

Postmodernism was erupting; Einstein had turned the scientific paradigm upside down. There was Chaos Theory and the complexity and quantum sciences to explain new realities. Suddenly systems were seen as dynamic and spontaneous, and relationships and patterns became new sources of wonder.

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Nursing’s thought leaders stepped forward to define the profession of nursing and provide a foundation for the science of nursing to come. This readied us for the postmodern era.

Everything was to begin to change ……

And here we are, still under the shadow of medicine and not realizing our distinct caring domain. Despite the expansion of the foundation for our knowledge development in ethics, esthetics and the personal, the majority of our knowledge acquisition is based in empirics.

Today, the strongest forces blazing our paths to our distinct professional practice are holistic nursing and Watson’s caring science. From these we learn ethics which helps us know, feel and act in accordance with what is right; esthetics helps us see beauty and feel the gestalt of each situation; and the personal helps us each find our emotional intelligence and caring consciousness.

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Watson provides the Caritas Model of Nursing, which identifies two services to humanity:

  1. “Overt service- the outer world of clinical practice at the body-physical, material-technological level of medical services, tasks, procedures, and so on.
  2. Subtle service – the inner world of practice at the heart level, evolving toward a higher consciousness that cultivates an awakening of the heart and mind, embracing the finest of the medicalized, technical outer world while consciously cultivating the subtle inner practices of evolving our own humanity.”                      Watson, p197

Reviewing this history helps us know our path,

and helps us each feel our way.


Carper BA. Fundamental patterns of knowing in nursing. ANS, 1978; 1(1): 13-24.
McClendon P. Discovery of Connections – Societal Needs, Nursing Practice, and Caring-Healing Theory: My Story. International Journal for Human Caring, 2005; 9(4): 8-13.
Watson J. Nursing – The Philosophy and Science of Caring, Revised Edition. Boulder: University Press of Colorado; 2008.
Zander PE. Ways of Knowing in Nursing: The Historical Evolution of a Concept. The Journal of Theory Construction & Testing, 11(1); 2000: 7-11.

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