This paper compares two influential nursing theories developed by Faye Abdellah and Jean Watson. It traces Abdellah's career and her formulation of 21 nursing problems and 11 nursing skills, which established nursing as a scientific discipline with a clinical, patient-centered focus. The paper then examines Watson's caring science philosophy, grounded in humanistic and metaphysical principles, which extends nursing beyond empirical methods into aesthetic, ethical, and spiritual modes of knowing. By exploring the origins, frameworks, and implications of each theory, the paper highlights how both thinkers shaped nursing's professional identity — one through scientific rigor, the other through interdisciplinary caring.
A profession's base of knowledge is normally expressed in the form of concepts, propositions, and theories. As with all areas of study, nursing theories are composed of concepts and the systematic connection of propositional statements. As a product of science, these theories form a central part of the discipline's basic understanding. Nursing has established a wide variety of theories over many years of care and service. Two of these theories — developed by Faye Abdellah and Jean Watson — illustrate some of the inherent differences within the field.
Born in New York City in 1909, Faye Abdellah graduated from Fitkin Memorial Hospital School of Nursing in 1942 and then earned three degrees at Teachers College at Columbia University: a B.S. in nursing and an M.A. and a Ph.D. in education. She was appointed Chief Nurse Officer for the U.S. Public Health Service and became the first woman and nurse to serve as Deputy Surgeon General. Her extensive experience in practice and education made her recognized as one of the leading researchers in health and public policy and international health (Haase, 1990, p. 59).
Abdellah's doctoral dissertation and subsequent work emphasized the continuous improvement of the clinical teaching area of nursing, which included developing an evaluation instrument for undergraduate nursing programs. She believed it was of the utmost importance that the field of nursing develop a strong scientific base of knowledge that would earn the profession full professional status (Haase, 1990, p. 59).
The conclusions of several studies led Abdellah and Levine (1954) to classify medical diagnoses into 58 different categories representing the issues nurses commonly face. In conjunction with faculty from 40 nursing schools, she created a typology of 21 nursing problems, which became the foundation of her nursing theory, with each typology representing a problem composed of related sub-problems. Abdellah's typology was divided into three areas: (1) the patient's physical, sociological, and emotional needs; (2) the forms of interpersonal relationships between nurse and patient; and (3) the common elements of patient care. These were published in the book Patient-Centered Approaches to Nursing (Donahue, 1996, p. 423).
For instance, the eleventh problem states: "To facilitate the maintenance of sensory functions." Because there are five senses, it is possible to list the concerns for the nurse to consider with each one. This theoretical framework has since been updated to reflect changes in the profession — for example, her categorization now also incorporates nursing diagnosis. Abdellah additionally identified 11 nursing skills to further develop the treatment typology, including observing health status, applying knowledge, educating patients and families, planning and organizing work, utilizing resource materials, solving problems, directing others' work, relying on the therapeutic use of self, and following nursing protocols. She viewed the 21 nursing problems and 11 skills as a unique totality of nursing knowledge, a concept essential for nursing as it evolved from a medical to a nursing model (Donahue, 1996).
Abdellah developed her theoretical approach in the 1950s to provide a clinical framework for nursing students and their curriculum — the assumption being that as nursing education improved, practice would improve as well. This clinical theory was designed to help practicing nurses better organize the administration of care and establish a scientific foundation for decision-making. Her classifications incorporated a range of research studies and outcome measurements. Abdellah consistently stressed the continued development of nursing's scientific base and outcome measures to demonstrate nursing's special contribution to healthcare. She believed her greatest accomplishment was helping to establish a foundation for nursing research as a science.
Before her theory, nursing was primarily practice-oriented. Through her work documenting the varying healthcare needs of different populations and conducting numerous studies, she demonstrated that nursing was indeed a science. One area of research, for example, concerned fetal alcohol syndrome among Navajo children: in the study, ten pregnant women did not have access to alcohol for approximately six months, and as a result, ten healthy babies were born. Others subsequently continued Abdellah's research into fetal alcoholism. Patient-Centered Approaches to Nursing emphasized this establishment of a new science and, in turn, led to many changes in nursing curriculum (Dodds, 2002).
"Watson's humanistic and metaphysical caring framework"
"Caring science expanding across disciplines and epistemologies"
Watson takes issue with the way nursing students are presently taught — filling out worksheets and reading texts — an approach she believes closes "our minds and hearts" as we read lists of quotes from nursing theorists across the decades. She envisions the future of nursing, should it survive, as depending on the field maturing as a distinct health, healing, and caring profession — which it always was throughout history but has not yet fully actualized. Nursing has the challenge of developing its own paradigm while simultaneously sharing it with others. All healthcare practitioners must work within a shared framework of caring relationships, together embracing healing arts, caring practices, and collaborative processes.
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