Development of a caring model applying the conceptual, theoretical and empirical structure from caring science theory

Abstract

Introduction:

This paper shows the development and implementation of a humanised nursing care delivery model for a tertiary institution, using Fawcett’s Conceptual, Theoretical, Empirical (CTE) structure. Watson’s Theory of Human Caring supported the proposed model through the theoretical component of using mid-range and situational theories and the empirical application of structural, process and result indicators.

Objective:

Develop and implement a nursing care model for clinical practice at a university hospital in Colombia.

Materials and methods:

Descriptive study developed in five phases: (1) recognising the need for a nursing care delivery model to guide nursing practice, (2) determining the characteristics of the context and the application scenario’s features, (3) examining the literature to determine the conceptual, theoretical and empirical elements required for model creation, (4) preparation for implementation and (5) follow-up to implementation.

Results:

Based on a literature review and expert consensus, it was possible to construct a care delivery model that reflects the articulation of medical care and the adoption of paradigmatic, philosophical, conceptual and empirical elements of the nursing discipline, allowing the identification of care objectives, adjusted to institutional culture.

Conclusion:

The developed nursing delivery care model focuses on the individual, family and caregiver, emphasising comprehensive, humanised, safe and efficient care.

Introduction

Nursing, as a professional discipline, is inherently focused on the care of individuals, emphasising their experiences with health and illness. Despite this focus, integrating nursing theory into clinical practice remains challenging. This challenge has led to a reliance on biomedical models, even within nursing care, potentially undermining the discipline’s unique and invaluable perspective in the healthcare system.

In this regard, Fuller, long ago (1978) declared that nursing, as a professional discipline, seeks to achieve independence and uniqueness in its knowledge, which has gradually developed through inquiry and reflection, empowering and granting autonomy to those who practise it (Meleis, 2007). Accordingly, several authors in the field of nursing have consistently emphasised the need to recognise that the science underlying the discipline of nursing has evolved from a focus on the natural sciences and is now described as a human science with unique properties that define the ontology and epistemology of the nursing discipline, shaping its perspective (Villalobos, 2007).

In recent years, there has been a growing interest in developing care models aligning with quality healthcare delivery systems. This interest stems from the need to ensure that nursing care is guided by the three core concepts identified as central to nursing practice and underpins nursing care: The nursing process, its theoretical and conceptual framework and Evidence-Based Nursing. These concepts serve as the foundation for the model, which is designed to guide nursing practice in a manner consistent with the discipline’s scientific and humanistic principles. These elements collectively help identify patient needs and guide effective care strategies.

In response to this need, we conducted a comprehensive review of nursing literature to identify a methodology that could support the development and implementation of a nursing care model tailored to the requirements of a healthcare institution in Colombia.

The primary aim of this research is to address the theory-practice gap by developing a conceptual model that integrates nursing theory more effectively into clinical settings. The proposed model seeks to align nursing practices with the discipline’s ontological and epistemological foundations, thereby enhancing the quality and relevance of nursing care.

Addressing the theory-practice gap is significant because it impacts patient outcomes and the autonomy of the nursing profession. By bridging this gap, the research aims to empower nurses, inspiring them to deliver scientifically sound care that aligns with the holistic principles of nursing.

However, it is important to note that the empirical evidence supporting the effectiveness of this model is currently limited. This underscores the need for further studies to validate the model and assess its impact on clinical practice. The development of this conceptual model represents a step towards closing the theory-practice gap, but its practical application and empirical validation remain critical areas for further research, inviting the audience to contribute to this ongoing process.

We selected the Conceptual, Theoretical, Empirical (CTE) system described by J. Fawcett (2013a) as the foundational framework for this model. The CTE system is particularly well-suited to nursing practice as it enables the identification, analysis and prediction of nursing phenomena through the application of critical thinking, clinical reasoning, interpersonal relationships, with better scientific evidence and ethical principles (Fawcett, 2013a). This approach not only enhances the quality and contextual relevance of nursing practice but also supports interdisciplinary communication and decision-making and strengthens professional identity and autonomy, contributing to greater job satisfaction among nurses (Garvey et al., 2019).

The CTE structure is advantageous as it organises specific nursing knowledge by articulating conceptual models with theories and empirical indicators, forming a holarchy of knowledge. This systematic approach underscores the explicit use of conceptual models and their derivative theories in nursing practice, allowing nurses to better understand the work of the nursing discipline and improve the care environment and patient outcomes (Vieira et al., 2021).

Within the CTE framework, the conceptual component (C) represents the most abstract element, encompassing the nursing model that articulates broad concepts and propositions to address phenomena, situations or circumstances of interest to the discipline (Fawcett, 2013b). The theoretical component (T) is more concrete, involving the use of mid-range and situation-specific theories that describe, explain, predict or prescribe nursing care. Finally, the empirical component (E) involves operationalising concepts and theoretical propositions through the nursing care process, using assessment instruments, protocols, intervention guides and evaluation tools (Fawcett, 2013a).

The application of the CTE structure fosters continuous improvement in care by promoting the use of interventions that respond to the needs of patients and their families. This approach ensures that nursing practice remains aligned with the organisation’s mission, vision and values while maintaining the primary focus on the health and care experience (Fawcett, 2021).

This paper aims to provide an accessible method for healthcare institutions seeking to improve care quality, empower nurses and highlight the critical role of nursing knowledge in clinical practice. Accordingly, this study focused on developing and implementing a nursing care model based on Jacqueline Fawcett’s CTE framework at the university hospital, a healthcare organisation that provides advanced services to a wide population in Northeast Colombia. The model emphasises patient-centred care that is comprehensive, humanised, safe and efficient. The conceptual component (C) of the model is based on Jean Watson’s Theory of Human Caring, which emphasises reciprocal, loving connections. This is harmonised with mid-range or situational theories in the theoretical component (T) and the nursing process in the empirical component (E) of the CTE structure.

Methodology

This descriptive study, conducted in 2023, outlines the phases involved in developing and implementing a model of nursing care delivery using the CTE framework as described by Fawcett (2013a) and is based on Jean Watson’s Caring Science Theory as the conceptual model – the C component in the CTE structure – at the university hospital, a tertiary healthcare institution. The research aimed to address the identified need for a structured nursing care model aligned with institutional policies and to provide a clear and effective guide for nursing practice. The development process was carried out in five distinct phases, led by a team of nursing professors.

The first phase focused on recognising the necessity of a Nursing Care Model to guide nursing practice and ensure alignment with the institution’s policies. The authors reviewed the report issued by the entity responsible for identifying, measuring and sharing best practices in quality and patient safety in Colombia. This report underscored the importance of a structured nursing care model that supports the organisational objectives and enhanced the autonomy of nursing professionals thereby driving quality improvement and patient safety in healthcare settings across the country. Health institutions require a framework that ensures safe, high-quality patient care, respects human dignity and fosters effective communication and coordination among healthcare professionals. This need, combined with the goal of achieving excellence in nursing and aligning with national and international trends, prompted the development of a nursing care model tailored to the university hospital.

In the second phase, the researchers examined the characteristics of the context and the application scenario of the institution including its mission, policies, organisational structure, nursing human resources, users’ demographics and service offerings. Understanding these factors was crucial to tailoring the care model to the specific context of the hospital.

In the third phase, a comprehensive literature review was conducted to determine the conceptual, theoretical and empirical elements of the selected nursing care model (The Joanna Briggs Institute, 2023). As a conclusion of the literature, the authors adopted the CTE framework (Fawcett, 2013a), grounding the care delivery model in Jean Watson’s Caring Science Theory, which was adapted to fit the institutional context.

The following phase was the preparation for the implementation. This phase involved preparing for the model’s deployment through a series of activities, including technological adjustments to nursing records, as well as training, coaching and supporting the nursing staff. The researchers emphasised the importance of understanding the conceptual elements of the model, the relevant mid-range or situational theories and the empirical indicators. A pilot test was conducted in the paediatric service to assess the model’s practicality and to refine the implementation process. The choice of this setting was intentional, given the distinct developmental and emotional needs of paediatric patients. The paediatric unit, comprising one charge nurse, seven registered nurses and twenty-two nurse aids, provided an ideal environment to assess the model’s effectiveness. By focusing on these contextual factors, we aimed to refine the implementation process while considering the specific challenges and dynamics of paediatric care.

Finally, the follow-up phase involved evaluating the implementation’s success. A nurse, who was not involved in the initial training, assessed 50% of the records in the pilot service to verify adherence to the care model. The evaluation results, including feedback on strengths and barriers, were presented to the research team for further refinement and decision-making. This methodology establishes the model in practice rather than a theory-based model.

Results

To identify the need for a caring model to guide nursing practice and articulate it with the institution’s policies

The first phase was identifying the need for a caring model that guides nursing practice and aligns with the institution’s policies. In this first stage, a thorough assessment was conducted at the university hospital, a tertiary care public health facility and teaching centre in the region of Colombia, South America. Since 2005 this hospital has prioritised continuous improvement in the care of low- and middle-income patients, adopting standards and processes to ensure safe and effective care delivery.

In the hospital’s commitment to providing humanised care, centred on patients, their families and caregivers, it became necessary to identify an appropriate practice model. This model needed to reflect the hospital’s mission of delivering quality care throughout the patient’s journey – from admission to discharge – while aligning with its strategic goals. In addition, the model had to be both practical and feasible for implementation within the clinical setting.

In the analysis, the nursing team recognised that globally, nursing practice has increasingly recognised the importance of using theory to enhance decision-making and care interventions. Conceptual models play a key role in guiding, understanding and improving nursing practice in various contexts (Fawcett, 2013a). As nursing is both a liberal profession and a social discipline (Congreso Colombia, 1996), it is essential that its practice be grounded in nursing theories and technologies. This theoretical foundation supports the delivery of high-quality care that meets both institutional and patient needs.

Determination of the characteristics of the context and the application scenario

In the second phase, we identified the characteristics of the context and the application scenario. Our research team, comprising faculty members from the Academic University and the university hospital, operates under a cooperative agreement designed to establish an effective university hospital model. As part of this partnership, the Universidad Industrial de Santander (UIS) oversees the hospital, particularly in managing nursing services. This hospital department is responsible for driving continuous improvement, leadership and professional empowerment within nursing care.

The nursing services at the university hospital are organised by areas of care based on the target population, including adult care, maternal and childcare, adult critical care and paediatric and neonatal care. These services cater to patients from Colombia’s Northeast region, with a significant portion of the population being migrants or individuals with low socio-economic status. The nursing team comprises area-specific nurse managers, specialist nurses, general nurses and nursing assistants, all responsible for providing direct and comprehensive care. The nurse–patient ratio ranges from 10–13 patients in general inpatient services to 3:1 in critical care settings.

A total of 205 nurses were analysed for this study. The majority (31%) were aged 25–31 years, with 31% having earned their professional degree in the past 3 years. Only 23.4% of the nurses had postgraduate qualifications, 32.2% had completed studies in standardised nursing language studies based on the taxonomies proposed by the North American Nursing Diagnoses Association (NANDA); Nursing Interventions Classification (NIC) and Nursing Outcomes Classification (NOC) and 25.4% had prior experience in institutions that implemented the nursing process or care models in service delivery.

During the first quarter of 2023, 5117 patients were admitted to the hospital, with 51% (n = 2610) being female. The largest age group was adults (33.64%), followed by the elderly (22.57%) and youth (21.72%). Statistically significant differences were observed between age groups across different service areas (p < 0.001). The analysis also showed 438 deaths during this period, with the adult intensive care unit accounting for the highest number of deaths (50.91%). Mortality rates varied significantly between services (p < 0.001).

In terms of care demand, the adult emergency service recorded 42% of discharges (n = 2,132), followed by gynaecological-obstetrics hospitalisation (13%, n = 654) and internal medicine hospitalisation (9%, n = 441). Most patients (50%) came from the urban area in the capital city of Colombia (50%) and its metropolitan area (17%), the remaining 33% were from other municipalities or departments.

Literature review to determine the selected model’s conceptual, theoretical and empirical elements, an approach to the care phenomenon

The third phase involved conducting a literature review, which led to the selection of a conceptual model to support the nursing framework at the hospital. In alignment with the hospital’s humanisation policy – aimed at providing compassionate, comprehensive care – and the existing model for humanised and safe patient care, the research team adopted the CTE structure of nursing knowledge, as proposed by Fawcett (2018). This structure provided a systematic framework for developing a nursing care model tailored to the institution’s needs.

The conceptual foundation of the model was based on Jean Watson’s Theory of Caring Science, selected due to its alignment with both the institution’s mission and the research team’s previous familiarity with this theoretical approach. Watson’s theory emphasises holistic, human-centred care, which resonates with the hospital’s focus on its humanisation policy consisting of delivering compassionate and comprehensive services.

The literature review, conducted in accordance with the guidelines of the Joanna Briggs Institute, too sought to identify the clinical contexts in which Watson’s Theory of Caring Science had been successfully applied. This review informed the development of the model’s core components within the CTE structure. The elements of the nursing care model included

• Conceptual framework (C): Jean Watson’s Theory of Caring Science, which provided the philosophical and ethical foundation for care practices.

• Theoretical framework (T): A selection of mid-range and situational theories, chosen based on the patient population and specific care needs within the unitary framework of the institution. For this proposed delivery model, the Caring Theory from Swanson was selected.

• Empirical framework (E): The nursing process, operationalised through the use of Watson’s 10 Caritas Processes, served as the empirical basis for care interventions and outcomes measurement.

This structured approach facilitated the integration of nursing knowledge into practice, ensuring that the care model was both theoretically sound and practically applicable in the clinical environment. Figure 1 illustrates the integration of the CTE structure in the nursing care model.

Figure 1.

Representation of the nursing model delivery care developed with its components.

This graphic shows the nursing model developed with its components.

The conceptual framework guiding the development of the Nursing Care Delivery Model was Jean Watson’s Caring Science Theory, which emphasises the patient as a whole person – body, mind and spirit (Fawcett, 2013a). This theory is grounded in a humanistic orientation where individuals are not treated as objects and are inseparable from their environments. Watson’s theory requires a heightened level of awareness about the multidimensional nature of human beings, prompting nursing to explore strategies that foster transpersonal connections between nurses and those they care for (Tonin et al., 2017).

Key to this theory is Watson’s 10 Caritas Processes^®, foundational of the model’s structure, which offer a universal language of human care. ‘Caritas’ signifies caring acts done with love, compassion and generosity of spirit. These Caritas processes equip nurses with guiding principles that enable the creation of healing environments, blending clinical and technological knowledge with deeply humanised care (Tonin et al., 2017; Watson, 2018). Another central concept is the ‘Caring Moment’, a significant point in time and space where the care interaction occurs, involving conscious choice by both the nurse and patient. ‘Caring Awareness’ is a transformative healing process, connecting the caregiver, the patient and the broader energies of the universe, facilitating a transpersonal relationship in which the nurse authentically connects with the patient’s spirit in the present moment.

Regarding the theoretical component (T), as mid-range theory. Mid-range theories provide a bridge between abstract theories and practice (Polit and Beck, 2017). The model also incorporated Swanson’s Theory of Caring, aligning with the transformative, unitary perspective. This theory emphasises that human beings should be viewed as inseparable from their environment, with person–environment interactions seen as rhythmic, mutual processes. In this unitary-transformative approach, the phenomena of nursing care are addressed holistically, where the individual is viewed as a unified entity in continuous interaction with their surroundings.

Finally, the empirical component (E) of the model took a systemic approach to care quality, rooted in both the nursing process and Watson’s Caritas Processes, supplemented by Swanson’s theory. Structural, process, and outcome indicators were established to assess the nursing model and the nursing interventions, highlighting the contribution of nursing to the institution’s caring approach. Measurement instruments were used to objectively evaluate the impact of the model, ensuring its alignment with nursing and organisational variables and providing a comprehensive assessment of its effectiveness.

Preparation for implementation

The fourth phase was the preparation to implement the structured nursing model. To facilitate the adoption of the Nursing Care Delivery Model, the research team carried out a series of three educational sessions for nurses in the paediatric hospitalisation services. These sessions were supported by nursing students from the School of Nursing at the Academic University, and all educational materials – both audiovisual and printed – were validated before use.

The first session introduced the nursing metaparadigm and core concepts of the model, such as the transpersonal caring relationship, caring awareness, caring moment and the 10 Caritas Processes^®. The primary objective for nurses in the pilot paediatric service was to internalise and apply these concepts. Training tools included a video presentation and individual cards for each Caritas Process to facilitate understanding.

In the second session, the focus shifted to the theoretical components of the model, particularly mid-range theories. Memory cards were used to enhance individual learning, and the session concluded with group feedback to reinforce comprehension and engagement with Watson’s and Swanson’s theories.

The third session covered the empirical component, concentrating on the development of nursing care plans using the nursing process (Assessment, Diagnosis, Planning, Implementation and Evaluation based on NANDA-NIC-NOC standardised nursing language; Zhang et al., 2021). This session emphasised integrating the Clinical Process of Caritas into daily practice. Nurses were trained to initiate care with the Five Senses Approach – using human touch and affection to connect with patients, fostering empathy, sensitivity and respect in transpersonal encounters. Nurses were also trained to cultivate active listening, presence and responsiveness, while honouring the beliefs and customs of each patient. Integrating standardised nursing languages (NANDA, NIC, NOC) with Watson’s models and Swanson’s theory enhances the delivery of humane and personalised care. This approach facilitates the identification of health problems, selection of targeted interventions and definition of clear outcomes, ensuring comprehensive patient care. By prioritising individual needs, it strengthens the nurse–patient relationship and promotes holistic well-being.

Following the educational sessions, the implementation phase in the real practice with patients began. For the conceptual component, Caritas spaces were created in various services to promote the fundamental concepts of Watson’s caring science theory, caring moment and transpersonal care, thus caring for the caregiver and promoting healing environments. In addition to the paediatric service, which was the first to fully implement the Caritas space, we established Caritas spaces in nine other areas of the hospital. These included the emergency department, inpatient units, internal medicine for both men and women, surgery, delivery room, neonatal unit, oncology, wound clinic and gynaecology. These spaces, equipped with chairs, relaxing music, calming colours and soothing scents, provided areas for reflection and practice of Caritas in daily routines. In addition, Caritas practices were introduced to start each nursing shift. These included mindfulness activities such as breathing exercises, gratitude practices and moments of forgiveness to promote presence and emotional well-being. The daily activities were agreed upon with the staff and led by the charge nurses, with support from nursing students and university faculty. For the theoretical component, Swanson’s Theory of Caring was integrated into the nursing process. Swanson’s theory, which views care as a nurturing way of relating to someone with whom one feels personally connected, consists of five basic processes. These were applied in the following ways: assessment: incorporating knowing and being with the patient; planning and execution: applying doing for and enabling the patient; throughout care: maintaining belief was emphasised to support patients’ dignity and individuality. This systematic integration of both Jean Watson’s Caritas and Swanson’s theory ensured a holistic, patient-centred approach in day-to-day nursing care practices. For the empirical component, the nursing care quality team measured the implementation of the model using nine specific indicators. These were designed to evaluate the impact of the model on care quality and incorporated structure, process and outcome metrics from the institution’s balanced scorecard. The indicators aimed to capture the transformation in nursing care and included:

• Percentage of perception of humanised care in hospitalised patients

• Percentage of adequate Caritas spaces in the hospital

• Percentage of perception of care during nursing interactions

• Percentage of nurses’ perception of transpersonal human care

• Percentage of nurses’ perception of their competence in the nurse–patient relationship

• Patient perception of care based on Kristen Swanson’s theory using the validated instrument in the Colombian context.

These indicators directly reflected the changes in care practices resulting from the implementation of the nursing care model.

Follow-up on implementation

In evaluating the model’s adherence within clinical nursing records using a check list, researchers found that 100% of the records (n = 11) demonstrated evidence of the model’s application, adhering to the established guidelines. On the other hand, we applied a perception of care during nursing interactions survey in which 54.5% of the nurses rated the quality of the documentation as excellent during the follow-up phase.

However, certain challenges were identified during the implementation. One notable issue was the time required for the nursing assessment by domains of NANDA, which was seen as excessive given the other direct care activities and care management tasks inherent to the complexity of the service. Another challenge was related to the hospital’s electronic medical record system. It was observed that the system neither did store information adequately, nor did it allow previous records to be consulted. This technical issue was subsequently addressed by the organisation in a problem-solving conference. Based on these findings, the research team developed a work plan aimed at improving the model’s deployment and ensuring its adoption across 100% of the services.

Before starting the training in the different sessions, researchers evaluated the nurses to determine the degree of knowledge of the participants about the concepts of the model and the mid-range theories, finding that 45% (n = 5 of 11) understood them. After finishing sessions 1 and 2, 100% of the nurses knew the topic addressed. In contrast, in session 3, a percentage of 72% (n = 8) was obtained at the beginning regarding the empirical components of the model. Moreover, the result was 100% knowledge at the end of the training.

Regarding the degree of satisfaction of the participants with the training process received, 40% stated they felt delighted, while the remaining 60% were satisfied. Following this training, the study team provided individual support to the nurses to complete the nursing care plan (assessment, nursing diagnoses, results and interventions) in the electronic medical record, achieving 100% implementation in the pilot service and 60% in other services. Patient satisfaction was assessed using the Watson’s Caritas Patients tool^®, which measures the perception of humanised care on a Likert scale (1 = no, 5 = always). This tool was validated in a Spanish context and applied to 79 hospitalised patients. The mean score was 4.6, reflecting a satisfaction rate of 92%.

In addition, we evaluated the transpersonal caritas relationship among nurses and their co-workers using the Watson’s Caritas Tool for Coworkers^®, which included 68 nurses from both paediatric and nine other services. The mean score was 4.3 (on a Likert scale from 1 to 5), indicating that the application of humane care among co-workers was rated at 86%.

Discussion

In alignment with the study’s objective, the implementation of the nursing care delivery model was successfully carried out and adapted to fit the organisational characteristics and the needs of the patient population served. The model, tested in a pilot phase, was well received by the nursing staff, demonstrating congruence with both institutional goals and nursing practice.

The application of the model required the definition of core components such as the nursing metaparadigm, philosophy, conceptual models, mid-range theories and empirical indicators. This foundational structure guided the implementation phase, reinforcing nurses’ understanding of how disciplinary knowledge informs care (Fawcett, 2021).

The scientific literature supports that when nurses base their practice on the CTE system, they are better equipped to systematically identify, predict, prescribe and control patient outcomes (Hansen and Dysvik, 2022). However, the theory-practice gap remains a significant barrier, with some nurses perceiving theories and models as irrelevant to real-world practice (Younas and Quennell, 2019). This gap underscores the ongoing challenge in nursing: translating theoretical models into concrete, actionable practices that meet the needs of patients in diverse clinical settings (Younas and Quennell, 2019).

Numerous studies have reported success in applying structured care models to improve nursing care, particularly those with a humanistic approach. These models emphasise individualised, safe and continuous care, framing nursing as a practice-based science focused on promoting health and well-being for both patients and caregivers with complex needs (Chesak et al., 2022). The impact of these models extends to enhancing nurses’ autonomy and governance in decision-making, further supporting the quality of care delivered.

Jean Watson’s Theory of Human Caring, which served as the conceptual basis for the implemented model, has been successfully applied in various clinical settings (Durgun Ozan and Okumuş, 2017; Pajnkihar et al., 2017; Sit et al., 2017). The theory’s emphasis on human, transpersonal and authentic care has been shown to foster positive nurse–patient relationships and enhance care outcomes. Watson (2018) also highlighted the importance of integrating this model into nursing education, as it differentiates care from the more medicalised, curative approach that has long dominated healthcare (Breneol et al., 2019).

Amidst ongoing changes in healthcare, there is a growing emphasis on models that incorporate comprehensive, patient-centred care. These models encourage active patient participation in planning and managing their health, positioning the patient as a key partner in care (Carvajal Hermida and Sánchez-Herrera, 2018; Guevara Lozano et al., 2019). Nurses play a critical role in this shift, as they provide care that fosters mutual growth and transcends traditional healthcare relationships (Hussey and Kennedy, 2016; Serna Restrepo et al., 2021).

Limitations

The main limitation of this study was the frequent job rotation which affected the continuity of the model’s implementation. To address this, the team instituted a systematic on-the-job training process that incorporated the structure and concepts presented in this study.

However, for long-term sustainability of the model, the organisation will need to implement structural measures, such as hiring and retaining dedicated personnel, to ensure consistent application and integration of the model into practice.

Conclusion

The nursing care model based on the CTE structure was collaboratively developed by the scholars from the Academic University and nurses from the university hospital. This model addresses the need to enhance nursing practice and aligns with the institution’s strategic objectives.

The theoretical framework, derived from Jean Watson’s Theory of Caring, emphasises structured, formalised professional care aimed at fulfilling human needs. In addition, the collaboration between academia and clinical practice facilitated the transition from theoretical concepts to practical applications, resulting in a differentiated nursing care delivery model.

Key points for policy, practice and/or research.

• Model appropriation takes years; it is necessary to continue the process systematically to achieve the proposed empirical results. To gain acceptance, nursing staff must engage in a constant process of learning and internalisation related to this appropriation.

• The implementation of theoretical nursing models requires the establishment of connections between research, theory and practice.

• The development and appropriation of initiatives for applying theoretical nursing models in the healthcare field allow the application of care based on the body of nursing knowledge, visualising the role of nursing.

Biography

Natalia Esquivel-Garzón has a doctorate in nursing, is a specialist in critical care nursing, a specialist in pedagogy and an associate professor with 20 years of clinical, teaching and research experience.

Mayut Delgado-Galeano, has a bachelor’s in nursing (honours), is a registered nurse with a solid background, and critical care nursing specialist – CCNU, has a master’s in nursing – MSN (with honours), master’s in epidemiology – MPH and is an associate professor with 20 years of clinical, teaching and research experience.

Marisela Marquez-Herrera is a registered nurse, critical care nursing specialist, is a master of nursing – MSN and an associate professor with clinical experience, and experience in human resource management in nursing, teaching and research.

Dora Inés Parra is a registered nurse (Cum Laude), management specialist, PhD candidate and an associate professor with 30 years of clinical experience and 20 years of experience in teaching, research in clinical management and cardiovascular prevention.