Philosophical and theoretical foundations

“Many of the terms that nurses use are ambiguous or difficult to interpret. Terms must be examined from a theoretical perspective to clarify their meaning ”.

                                                                                                                                            Prof. J. Paley

How not to clarify concepts in nursing.

J Adv Nurs , 1996 24: 572-8. 


The ATIC philosophical and theoretical foundations have been made explicit on multiple occasions over the years. For the purposes of theoretical categorization, the interpretative conceptualization published by the author of ATIC in several scientific papers on the meta-paradigmatic constructs of nursing – individual, health, environment and nursing -, as well as on the nursing care process and its components, they may be considered a mid-range theory.


In order to facilitate the understanding of the philosophical and theoretical foundations on which ATIC is based, a brief summary is presented below, synthesizing the main influences of each philosophy, school of thought or theory in nursing or other basic and social sciences, in the development of the ATIC terminology, ontologies and analytical tools.


This section is NOT intended to be an explanatory text of nursing philosophies, models and theories. The explicitness of a model or theory is only indicative of its influence on the development of ATIC. Please, consult the reference works for more information on each paradigm, model or theory.

Philosophical trend that suggests scientific knowledge is fallible by nature, assumes uncertainty and the likelihood of error and emphasizes the need for a critical and permanent review of scientific assumptions.

Selected authors:

  • Karl Popper
  • Thomas Khun .

Influence on ATIC:

Nursing practice has to be safe and evidence-based, although both practice and evidence are not free from the likelihood of random, systematic or omission error. 

Scientific assumptions are not permanent or unquestionable. Neither are the language systems. Scientific evidence involves implementing the findings of the highest quality research studies, as well as considering professionals wisdom and preferences of the beneficiaries of care.

Philosophy oriented to the resolution of problems in practice, based on the understanding of reality from an empirical point of view. The meaning of the ideas is conditioned by criteria of practical utility and their value lies in the practical consequences of their use, acceptance and outcomes.

Selected authors:

  • Charles Pierce
  • William James.

Influence on ATIC:

The starting point must be experience, not language.

Language is a tool, not an end.

Practice leads the way beyond the capacity of any language system to represent it.

Multidisciplinary approach to epistemological and philosophical views that postulates knowledge is an active process of construction and elaboration, not only reception.

Phenomenology focuses on the understanding of meanings and human experiences, highlighting the importance of history and individual and social context, knowledge and preconceptions, as well as their role in judgment and decision-making processes.

Selected authors :

  • John Dewey
  • Jean Piagget
  • Martin Heiddeger
  • Hans-Georg Gadamer

Influence on ATIC:

  • Knowledge is dynamic and requires self-reflection and shared reflection.
  • Information reception by itself does not generate knowledge.
  • Individual or collective experience and context are vital in decision-making.
  • Meanings are driven by human experience.
  • Prejudices and values modify meanings and decision-making.

From the greek term “Holo” (full or complete), this humanist philosophy poses the  fundamental idea that “The whole is more than the sum of its parts” and that when observing the whole, realities and effects other than those produced by its parts are evidenced.

Selected author:

  • Jan Christian Smuts

Influence on ATIC:

Human being are entire. Their parts include a physical being, a conscious being, an autonomous being, their interactions and the interrelation with the environment.

Information needs are different in each stage or level of the healthcare systems, so no language system currently covers the whole range of needs.

Framework for the study and understanding of complex systems and theirs interactions. The more complex a system is, the greater its vulnerability and its likelihood to become unstable. Complex systems have the ability to self-organize and change to adapt and increase their survival and effectiveness. They are characterized by the absence of linearity and a dynamic of chaos; one event can affect any other, exponentially maximizing the unpredictability of the outcomes.

Selected authors:

  • Edward Lorenz
  • Benoit Mandelbrot
  • Ilya Prygogine

Influence on ATIC:              

  • People and their environments are complex systems unto themselves.
  • Healthcare settings are complex systems.
  • Care complexity is the result the interaction among individual complexity, risk of mortality, therapeutic complexity, procedural complexity and care settings environment complexity.
  • Professional experience and expertise may act as aggravating or mitigating factors.
  • Complexity and intensity of nursing care are borderline concepts, not synonymous.
  • The nursing process is not linear but circular and iterative. 
  • The greater the complexity, the greater the risk of instability. The greater the number of intervening factors, effect-modifying and confounding variables, the lower the probability of a proper prediction outcome.
  • Health problems undetected or unaddressed  in time, exponentially increase the risk of far more serious events and complications (butterfly effect). 
  • Prevention is a cornerstone at all levels of care, not only in primary and community care. 
  • Nursing care workload equivalent is the multiplication, not the sum, of squared complexity (E = mc2).

Framework proposed as a cluster approach to the study of the phenomena of classical physics and quantum mechanics under a common scheme.

Selected author:

  • Stephen Hawking

Influence on ATIC:

  • Everything is related. Sciences are nourished from knowledge they produced internally and knowledge generated by the other disciplines.
  • The greater the ability to integrate knowledge, the easier it will be to refine clinical judgment.
  • Conceptual models from each school of thought may coexist in harmony. There is no single way to construe and understand phenomena of disciplinary interest. Each theoretical contribution creates value. No conceptual model has been proved better than others.
  • To schematize an assessment data model according to tenets of a conceptual model is not equivalent to integrate a model into practice. Conceptual models cannot be implemented in practice, they may be operationalized by patient care provision and work environment improvement projects, as well as by conveying their values to imbue the entire professional practice.

Mathematical theory that describes a set of elements, parts or fragments presenting self-similarity in a wide scale range, even as a whole, as if they were small copies of the same figure or geometric shape. Nature presents multiple elements with fractal structures. Infinite iterations of simple processes become extremely complex processes. 

Selected author:

Benoit Mandelbrodt

Influence on ATIC:

  • Data models can be considered as fractals.
  • Self-similarity applies to the behavior and evolution of multiple health conditions and processes, so their identification and approach at population or group level may be similar to the individual level and vice-versa. This contributes to the rationale for the use of individually-adjustable population care standards.
  • Likewise, this conception impacts the terminology developments, in order to avoid duplicities, optimize the use and the reutilization of data in and among information systems. The property of self-similarity guides the prioritization of data in each clinical situation of the beneficiary of nursing care.

Philosophy and social movement that advocates for gender equality and recognition of women’s rights throughout the world.

The ethics of care is based on equality with an emphasis on respect for diversity and the satisfaction of one’s own needs and those of others.

Selected authors:

  • Simone de Beauvoir
  • Betty Friedan
  • Concepción Arenal
  • Carol Gilligan
  • Joan Tronto

Influence on ATIC:

  • The nursing profession and its practice is autonomous by definition and right.
  • Registered nurses and its scope of practice is not homogeneous in the world and evolves linked to the progress of women’s rights acknowledgment in each country or region.
  • Within the nursing profession, there should no longer persist the message of an autonomous role and a collaborative role. The assumption of accountability is inherent to any profession. Co-responsibility is frequent in healthcare professional practice mainly related to the complexity of health problems and situations to prevent, address, treat or palliate, requiring judgment and intervention of multiple professionals, whose autonomous exercise contributes symmetrically with knowledge and expertise to identify and manage health challenges. 
  • Co-responsibility should also be shared with the beneficiary of nursing care, in the context of their rights and autonomy for decision-making.
  • Delegation of competences (areas of professional scope of practice) among professions is an accountability dislocation. Delegation of tasks should be limited from professional level to technical level. Registered nurses as professionals, are able to delegate tasks to nurse aids or technicians. A profession cannot delegate scopes of practice to other professions; they are at a same level of responsibility. A professional can ask for advice, cooperation or opinion to another professional.
  • There exist some intersecting areas among scopes of practice of the healthcare professions, indicating areas of shared accountability that must be assumed in symmetry and harmony.
  • The concept of “physician’s orders” is outdated. The autonomy of the healthcare beneficiary is acknowledge by right in most countries. Physicians may propose, suggest, orient and advice patients, but it is the patient decision. Physicians can request nursing services when the patient does not know, cannot, is not able to understand or perform an intervention by themselves. 

Reference framework on the process and outcomes of human decision-making and its translation to information systems, robotics and artificial intelligence, based on three main statements :

  • Expertise is acquired through reflexive practice.
  • Five categories of expertise are identified: learner, advanced beginner, competent, proficient and expert.     
  • Not everyone will achieve the expert level. Expertise distributes following a normal curve (Gauss’ bell).

Selected authors:

  • Hubert and Stuart Dreyfus
  • Patricia Benner.

Influences on ATIC:

  • Language systems should consider the representation of knowledge at each of the different levels of expertise.
  • A proficient or expert nurse has greater clinical expertise, greater analytical capacity and clinical reasoning abilities. Consequently, it is better equipped to refine an accurate identification of the individual status and anticipate their progress, as well as to more precisely identify the interactions of their history, context and influence.
  • In practice, the different levels of expertise coexist in a relatively stable manner.
  • The greater the expertise, the less the influence of the organizational context on clinical decision-making. The actual expert professional is better equipped to adapt, adjust or ignore a standard, protocol, or procedure to offer a more accurate clinical response to the person’s problem or needs.

An ensemble of epistemological approaches, including developments from different disciplines, whose common basis is health promotion and disease prevention at all levels, from individual to population, as well as the acknowledgment of the importance of the social environment (social determinants of health, cultural, economic, political, legal, historical and structural factors) and of the natural environment in human health.

Selected authors :

  • World Health Organization
  • See Richard L et al. Ecological models revisited: Their uses and evolution in health promotion over two decades. Annual Reviews of Public Health 2011 32: 307-26.

Influences on ATIC:

  • Nursing practice is essentially based on prevention at all population levels (individual, group, community, population), in all age groups and at all levels of care.
  • The study and practice of Nursing are based not only on the approach to actual health conditions and health situations, but on the consideration of anticipating and managing risks; what may happen considering the vulnerability and risk factors of each person, group or population.
  • Population or group standards are applicable and must be adjusted to the individual context of each person.
  • The analysis of individual cases or case series may contribute to set population care standards in the absence of better scientific evidence.

Epistemological approach to the provision of professional nursing care based on the influence of the environment on health and healing processes, the importance of hygiene and individual and collective care in the prevention of infections and other conditions, the need to document the process and outcomes of nursing care, including the status and progress of patients, and statistically analyze data, to measure the impact of professional nursing care on health and mortality outcomes.


  • Florence Nightingale

Influences on ATIC:

  • The environment exerts a positive or negative influence on the course of the disease or health situations.
  • Prevention of diseases, complications and disabilities is a cornerstone of the nursing profession and its main social contribution.
  • Nursing care has a healing effect by itself.
  • Documentation is part of the nursing care, not and additional or secondary issue.
  • Statistical analysis is a key to manage nursing care and its outcomes. 

It includes the works of the theorists from the needs, the interaction and the outcomes schools of thought, as well as other theoretical orientations. Essentially, they all imbue the conception of the human being as an integral being with biological, physical, mental, emotional, social, moral and spiritual components in constant interaction with the environment, as well as the autonomy and self-care, the concept of health as a process of well-being, not only as the absence of disease, the importance of interactions, roles, relationships and environment in health, and the concept of Nursing as an autonomous profession.

Selected authors:

  • Needs school of thought: 
    • V . Henderson
    • D. Orem
    • FG Abdellah
  • Interaction school of thought:
    • H. Peplau
    • I. King
    • IJ. Orlando
    • J. Travelbee
  • Outcomes school of thoght:
    • C. Roy
    • ME. Rogers
    • ME. Levine
    • DE Johnson
  • Other theorists: 
    • J. Fawcett
    • N. Pender
    • M. Leninger
    • P. Barker

Influences in ATIC:

  • Nursing is a multiparadigmatic scientific discipline , which uses process engineering in its practical application to the prevention and resolution of individual, group, community and population health problems and situations.
  • No philosophy or conceptual model prevails in importance, impact or time over the others.
  • Assumptions, beliefs and principles about the nature of nursing coexist and evolve through mid-range theories and nursing research. What indeed prevails are the metapardigm phenomena of Nursing study and practice decribed by Fawcett: person, health, environment and nursing.
  •  Nursing is a basic health, social and applied science.
  • The process of care provision or nursing process is the systematic method of professional nursing care services delivery.
  • Conceptual models and high-range theories determine practice at an abstract level, orienting the values that must permeate it. They have no direct practical application. Their assumptions and propositions are operationalized and demonstrated by means of qualitative, mixed or quantitative research to generate mid-range theories and applicable results. 
  • Prevention of diseases, complications and disabilities, self-care and health promotion are core elements.

Conceptual framework of the nursing discipline for knowledge management in information systems. The acronyms correspond to concepts: Data, Information , Knowledge and Wisdom (Data, Information, Knowledge and Expertise).

Selected authors:

  • JR. Graves
  • S. Corcoran
  • R. Nelson
  • I. Joss 

Influences in ATIC:

  • Data are discrete entities or units, not individually or textually interpretable.
  • Information is generated with the interpretation of multiple data.
  • Knowledge is generated by relating and comparing multiple sets of contextualized data and information.
  • Wisdom implies the proper and empathetic application of knowledge to meet the needs, prevent, solve or palliate health problems.
  •  The ATIC knowledge tools should allow data and information to be properly represented in the information systems, in a structured manner, logic and empathetic for the user nurse, to assure patient safety, foster nursing knowledge and nurses’ expertise growth and contribute to improve health outcomes. 

The content of this section should be referenced:

Juvé-Udina , ME. Philosophical and theoretical influences and assumptions in ATIC. ( ATIC CARE )

For more information, see the Publications section.