Comparing Florence Nightingale Jean Watson Dorothea Orem

Comparing Florence Nightingale Jean Watson Dorothea OremIntroduction

Nursing is undoubtedly one of the most esteemed professions globally, given its pivotal role in patient health and recovery. At the heart of nursing practice lie various guiding concepts that have evolved over time. These conceptual frameworks have a rich history, dating back to the pioneering work of Florence Nightingale (Marriner-Tomey & Alligood, M. R. (2017). Subsequent nursing scholars, including Jean Watson and Dorothea Orem, have significantly contributed to the landscape of nursing theories. Although the maturity of these theories is sometimes questioned, they collectively provide invaluable guidance for understanding and shaping nursing practice (Smith & Parker, 2022, p. 67). Among the prominent nursing theorists, Florence Nightingale, Jean Watson, and Dorothea Orem stand out. This paper looks into the nursing theories developed by these influential figures, highlighting the differences and similarities in their perspectives on nursing.

Florence Nightingale’s Environmental Theory

Florence Nightingale, often affectionately known as the “Lady with the Lamp,” stands as a true pioneer in the field of nursing and one of the earliest nursing theorists. Her remarkable contributions during the 19th century laid the very foundation upon which modern nursing practices and nursing theories have been built. Nightingale’s Environmental Theory, alternatively referred to as the Environmental Adaptation Theory, remains a fundamental cornerstone of nursing philosophy, exerting an enduring influence on the practice of nursing even today (Donaldson & Crowley, 2020, p. 92).

At the heart of Nightingale’s theory lies a profound understanding of how the environment profoundly impacts patient health and recovery. In an era when medical treatments often lagged behind and yielded limited success, she astutely recognized the pivotal role that the conditions in which patients received care played in determining their outcomes. Her meticulous observations, notably during the Crimean War, shed light on the dire conditions within military hospitals and the devastating toll it exacted on patient survival rates (McEwen & Wills, 2019).

Nightingale’s theory revolves around the belief that modifying a patient’s environment can establish conditions conducive to healing and recuperation. She ardently advocated for an environment that supplied the fundamental elements crucial for recovery, such as access to fresh air, clean water, proper sanitation, and adequate nutrition (Smith & Parker, 2022, p. 89). Nightingale’s emphasis on these basic requirements triggered a revolution in healthcare practices, ushering in significant enhancements in patient outcomes.

Yet, Nightingale’s theory extended far beyond the confines of the hospital room. She recognized that the environment encompassed not only the physical aspects but also the social and psychological dimensions. Her unwavering advocacy for improved living conditions, public health measures, and sanitation was not limited to the hospital setting but extended to the broader community. Nightingale possessed a deep understanding of the interconnectedness between community health and the well-being of individual patients (McEwen & Wills, 2019).

Furthermore, Nightingale’s theory underscored the pivotal role of the nurse in crafting a therapeutic environment. She firmly believed that nurses should serve as staunch advocates for patients, ensuring that their physical, emotional, and psychological needs were met. This foundational concept paved the way for our contemporary understanding of nurses as holistic caregivers, responsible not only for promoting physical recovery but also for nurturing emotional well-being (Alligood, 2017).

Jean Watson’s Caring Theory

Jean Watson’s Caring Theory stands as a transformative and human-centered approach to nursing that has reshaped the way healthcare professionals view their role in patient care. Watson’s theory diverges from traditional medical models, placing paramount importance on the human connection and the profound impact of genuine care in nursing practice (Alligood, 2017).

Watson firmly believes that caring is the cornerstone of nursing and the most invaluable contribution that nurses make to humanity. In her view, true health cannot be achieved without authentic care. Through caring interactions, nurses empower patients not only to regain their physical well-being but also to gain knowledge, regain control over their lives, and ultimately foster their own recovery (Jones & Nelson, 2021, p. 143).

One of the distinguishing features of Watson’s theory is its emphasis on autonomy and freedom of choice for patients. Unlike some other nursing theories, Watson’s approach places patients at the forefront of their recovery journey, with nurses as facilitators of their healing process. This perspective transcends the purely objective assessment of symptoms and treatments. Instead, nurses engage with patients on a deeper level, honoring their dignity as unique individuals with their own values and beliefs. According to Watson, the act of caring possesses inherent healing potential through intentional connection, deep perception, and shared experiences (Jones & Nelson, 2021, p. 143).

Watson introduces the concept of “caring occasions” in her theory. These are moments when nurses and individuals interact in ways that foster genuine human connection. During these moments, there is a profound exchange of experiences, encompassing not only physical sensations but also emotions, spiritual beliefs, thoughts, and environmental considerations. These caring occasions become integral parts of individuals’ personal histories, leaving a lasting impact on their well-being (Jones & Nelson, 2021, p. 143).

Central to Watson’s Caring Theory are the ten carative factors, which form the cornerstone of nursing’s human dimension. These factors guide nursing practice by addressing both the giver and receiver of care. They include fostering a humanistic value system, cultivating sensitivity, instilling faith and hope, nurturing caring relationships, employing creative problem-solving, creating a supportive environment, providing gratification assistance, promoting transpersonal learning-teaching, and harnessing phenomenological-spiritual forces (Johnson & Smith, 2020, p. 103).

Watson’s theory has had a profound impact on nursing practice and education. It has transformed the way nurses approach patient care, placing a strong emphasis on empathy, compassion, and the nurturing of human connections. Moreover, Watson’s theory has been extensively studied and applied in various healthcare settings, demonstrating its effectiveness in improving patient outcomes and enhancing nurse-patient relationships (Fitzpatrick & Whall, 2020).

Furthermore, Watson’s theory has been adapted to address cultural diversity, making it a valuable framework for culturally competent care. This adaptability underscores the theory’s relevance in an increasingly diverse and globalized healthcare landscape (Leininger & McFarland, 2002).

Dorothea Orem’s Self-Care Theory

Dorothea Orem’s Self-Care Theory has made significant strides in the field of nursing, underscoring the pivotal role of self-care in upholding optimal health and overall well-being. Orem’s theory has found broad acceptance in nursing, offering a comprehensive framework for understanding how individuals can actively engage in self-care to bolster their health. According to Orem, each person bears the responsibility and capacity to partake in self-care activities, with nursing stepping in when individuals encounter challenges meeting these self-care needs due to various factors (Taylor, 2019).

Orem’s theory is structured around three core components: universal self-care needs, developmental self-care needs, and health deviation self-care needs. These components serve as the bedrock for comprehending the significance of self-care in promoting health and managing illness or disability.

  1. Universal Self-Care Needs: These needs form the bedrock of maintaining health and well-being, encompassing activities such as maintaining proper nutrition, personal hygiene, adequate hydration, and securing sufficient rest. Orem recognized that these fundamental self-care practices are essential for individuals to safeguard their health and fend off illness.
  2. Developmental Self-Care Needs: Orem’s theory recognizes that individuals must learn and adapt throughout their life journey to maintain their well-being. These developmental self-care needs encompass activities related to physical, emotional, and psychological growth and transformation. For example, a teenager may need guidance on managing stress and nurturing emotional well-being as they navigate the path to adulthood.
  3. Health Deviation Self-Care Needs: When individuals confront hurdles related to illness, injury, or disability, they may require assistance with self-care activities. Orem’s theory acknowledges the indispensable role of nursing interventions in such circumstances. Nurses play a pivotal part in pinpointing the barriers preventing individuals from fulfilling their self-care requisites and offering suitable interventions to facilitate healing and recovery (Taylor, 2019).

Dorothea Orem’s Self-Care Theory bears tangible implications for nursing practice. It accentuates the patient’s active role in self-care and fosters a sense of independence and empowerment. By encouraging individuals to take an active role in their own care, nurses empower patients to assume control over their health and overall well-being (Taylor, 2019).

Furthermore, Orem’s theory serves as a foundational framework for crafting nursing interventions in diverse healthcare settings. It is especially pertinent in the management of chronic diseases and rehabilitation, where patients may need guidance and support to regain their independence and self-care abilities (Taylor, 2019).

Moreover, Orem’s pioneering work has contributed to the development of nursing assessment tools and care planning frameworks, rendering it a valuable resource for evidence-based practice. Nurses can leverage Orem’s theory to assess patients’ self-care capabilities, identify areas where assistance is required, and design individualized care plans that foster self-care and recovery (O’Neal, 2017).

Comparing Florence Nightingale, Jean Watson, and Dorothea Orem’s Nursing Theories

Focus of Nursing Theories:

  • Florence Nightingale: Her Environmental Theory primarily concentrates on the significance of the environment in healthcare and patient outcomes. She emphasizes the role of nurses in creating a conducive environment for healing.
  • Jean Watson: Watson’s Caring Theory revolves around the power of genuine care and the nurse-patient relationship. It highlights the importance of human connection, empathy, and patient autonomy.
  • Dorothea Orem: Orem’s Self-Care Theory centers on self-care as a means to maintain health and well-being. It underscores patients’ active involvement in their care and the nurse’s role in assisting when needed.

Key Concepts:

  • Florence Nightingale: Environmental factors, basic patient needs, holistic nursing care.
  • Jean Watson: Caring interactions, human connection, ten carative factors, transpersonal caring.
  • Dorothea Orem: Self-care, universal self-care needs, developmental self-care needs, health deviation self-care needs.

Patient Autonomy:

  • Florence Nightingale: Nightingale’s theory does not explicitly emphasize patient autonomy but focuses more on the environmental aspects of care.
  • Jean Watson: Watson’s theory strongly advocates for patient autonomy and empowerment. It places patients at the center of their care journey.
  • Dorothea Orem: Orem’s theory encourages patient autonomy and self-care, emphasizing that individuals have the responsibility and capacity to engage in self-care activities.

Nurse’s Role:

  • Florence Nightingale: The nurse’s role is to create a therapeutic environment and advocate for patients’ physical and emotional needs.
  • Jean Watson: The nurse’s role is to foster caring relationships, honor patients’ uniqueness, and facilitate healing through genuine caring interactions.
  • Dorothea Orem: The nurse’s role is to support and assist patients in meeting their self-care needs when they are unable to do so independently.

Application in Nursing Practice:

  • Florence Nightingale: Nightingale’s theory is foundational in nursing practice, especially in creating a healing environment.
  • Jean Watson: Watson’s Caring Theory has influenced nursing practice by emphasizing empathy and human connection.
  • Dorothea Orem: Orem’s Self-Care Theory is particularly relevant in cases of chronic diseases and rehabilitation, where patients need guidance in regaining self-care abilities.

Cultural Competence:

  • Florence Nightingale: Her theory does not explicitly address cultural competence.
  • Jean Watson: Watson’s theory has been adapted to address cultural diversity, making it suitable for culturally competent care.
  • Dorothea Orem: Orem’s theory does not specifically address cultural competence but can be applied in a culturally sensitive manner.

Discussion on Comparing Florence Nightingale Jean Watson Dorothea Orem

Florence Nightingale, Jean Watson, and Dorothea Orem stand as pillars of nursing theory, each offering a distinct yet interconnected perspective that collectively enriches our understanding of nursing practice. Nightingale’s Environmental Theory serves as a foundational reminder of the critical role the environment plays in patient health and recovery. Her emphasis on creating a healing space resonates with the broader notion that the physical setting in which care is provided can profoundly impact outcomes. Nightingale’s insights remain timeless, urging us to prioritize the nurturing of environments conducive to well-being.

In contrast, Jean Watson’s Caring Theory injects the human element into nursing, positioning authentic care and meaningful connections as central to the nursing profession. Watson’s theory invites nurses to see beyond the clinical tasks and embrace their role as compassionate caregivers. It champions patient autonomy and underscores the transformative power of empathy. In a healthcare landscape often driven by technology and efficiency, Watson’s theory reminds us of the enduring value of the human touch.

Complementing these perspectives, Dorothea Orem’s Self-Care Theory shines a spotlight on the concept of patient self-care and personal responsibility for health. Orem’s framework encourages individuals to actively engage in their well-being, aligning with the current trend towards patient-centered care. It acknowledges that patients possess the capacity and agency to participate in their care, thus promoting empowerment and independence.

Together, these theories reveal the multifaceted role of nurses in society. They demonstrate that nursing is not merely a profession of tasks and procedures but a holistic practice that encompasses the physical, emotional, and environmental dimensions of care. These nursing theories continue to guide practice, research, and education, underlining the enduring relevance of nursing theory in the ever-evolving healthcare profession.


In summary, while Florence Nightingale’s Environmental Theory focuses on the environmental aspects of nursing, Jean Watson’s Caring Theory highlights the importance of the nurse-patient relationship and patient autonomy. Dorothea Orem’s Self-Care Theory emphasizes self-care and the role of nurses in assisting patients when needed. Each theory brings a unique perspective and set of principles to the nursing profession, enriching the toolkit available to nurses as they navigate the diverse and complex needs of patients in different healthcare contexts.

These nursing theories, while distinct in their approaches, share a common commitment to holistic care. They remind us that nursing is more than a profession; it’s a calling to heal not only the body but also the spirit. In a healthcare landscape marked by ever-advancing technology and evolving patient needs, these theories serve as timeless beacons, guiding nurses in their mission to provide compassionate, patient-centered care.

As nurses navigate the diverse and complex needs of patients in different healthcare contexts, the insights offered by Nightingale, Watson, and Orem continue to enrich and inform nursing practice. Their enduring legacies remind us of the dynamic nature of the nursing profession and its essential role in promoting health, restoring well-being, and fostering human connection in the ever-changing world of healthcare.

Reference List

Alligood, M. R. (2017). Nursing theorists and their work. Elsevier Health Sciences.

Donaldson, S. K., & Crowley, D. M. (2020). The Discipline and Teaching of Nursing Process: An Evaluative Review. Springer Publishing Company.

Fitzpatrick, J. J., & Whall, A. L. (2020). Conceptual models of nursing: Global perspectives. Appleton & Lange.

Johnson, M. E., & Smith, L. N. (2020). Applying Nursing Theory to Evidence-Based Clinical Practice. Springer Publishing Company.

Jones, K. A., & Nelson, P. A. (2021). Nursing Theories and Conceptual Frameworks. Springer Publishing Company.

Leininger, M. M., & McFarland, M. R. (2002). Transcultural nursing: Concepts, theories, research & practice. McGraw-Hill.

Marriner-Tomey, A., & Alligood, M. R. (2017). Nursing Theorists and Their Work-E-Book. Elsevier Health Sciences.

McEwen, M., & Wills, E. M. (2019). Theoretical basis for nursing. Wolters Kluwer Health.

O’Neal, P. V. (2017). The Self-Care Deficit Nursing Theory in Pediatric Nursing. Pediatric Nursing, 43(1), 37-39.

Smith, M. C., & Parker, M. E. (2022). Nursing Theories and Nursing Practice. F.A. Davis Company.

Taylor, S. G. (2019). Dorothea Orem’s Self-Care Deficit Theory of Nursing: A 21st Century Reappraisal. Nursing Science Quarterly, 32(4), 297-300.

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