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The Careful Nursing philosophy and professional practice model


  • Therese C Meehan

    1. Author: Therese C Meehan, RGN, PhD, Adjunct Senior Lecturer in Nursing, School of Nursing, Midwifery and Health Systems, University College Dublin, Ireland and Adjunct Professor, Graduate School of Nursing, Midwifery and Health, Victoria University of Wellington, Wellington, New Zealand.
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Therese Connell Meehan, Adjunct Senior Lecturer in Nursing, School of Nursing, Midwifery and Health Systems, UCD, Belfield, Dublin 4, Ireland. Telephone: +353873187226.


Aims and objectives.  To present the Careful Nursing philosophy and professional practice model which has its source in the skilled practice of 19th century Irish nurses and to propose that its implementation could provide a relevant foundation for contemporary nursing practice.

Background.  Nursing models are widely considered not relevant to nursing practice. Alarming instances of incompetent and insensitive nursing practice and experiences of powerlessness amongst nurses are being reported. Professional practice models that will inspire and strengthen nurses in practice and help them to address these challenges are needed. Nursing history has been suggested as a source of such models.

Design.  Discursive.

Methods.  Content analysis of historical documents describing the thinking and practice of 19th century Irish nurses. Identification of emergent categories and subcategories as philosophical assumptions, concepts and dimensions of professional nursing practice.

Results.  A philosophical approach to practise encompassing the nature and innate dignity of the person, the experience of an infinite transcendent reality in life processes and health as human flourishing. A professional practice model constructed from four concepts; therapeutic milieu, practice competence and excellence, management of practice and influence in health systems and professional authority; and their eighteen dimensions.

Conclusion.  As a philosophy and professional practice model, Careful Nursing can engage nurses and provide meaningful direction for practice. It could help decrease incidents of incompetent and insensitive practice and sustain already exemplary practice. As a basis for theory development, it could help close the relevance gap between nursing practice and nursing science.

Relevance to clinical practice.  Careful Nursing highlights respect for the innate dignity of all persons and what this means for nurses in their relationships with patients. It balances attentive tenderness in nurse–patient relationships with clinical skill and judgement. It helps nurses to establish their professional practice boundaries and take authoritative responsibility for their practice.