Contributor – Miriam Hirschfeld, DNSc, RN

In my prior life, teaching in Tel-Aviv University’s nursing master’s program I volunteered to teach a course on nursing theory. I had two objectives, the first was a decision to learn these theories in some depth, the second to honor my revered teacher at UCSF, Dr. Afaf Meleis.

Many of these theories had appeal for me: Reva Rubin’s, Myra Levine‘s, Dorothea Orem’s, and others. Later, in my role as the World Health Organization’s (WHO’s) Chief Scientist for Nursing, a fancy title for a difficult job, I was asked to explain my understanding of nursing at conferences, worldwide. I developed a framework to be able to explain.

I believed that nursing had responsibility to provide equitable, high quality and affordable care, (given the resources, a necessary precondition!) along the three axes: the life cycle, from conception to the grave, the axis of continuity of care – preventive, curative, rehabilitative, long term, or chronic care, as well as palliative care. The third axis was the focus of our care – an individual human being, a family, a community, an aggregate (e.g., school or factory) and nursing’s challenge to influence health and social policies on local, national, and global levels.

This “Hirschfeld Model” was noted in Swiss legislation (Pflegekontinuum nach Hirschfeld, 2005).

Later I had some involvement in the development of the International Classification of Functioning, Disability and Health (ICF). TheICF is the World Health Organization’s (WHO) framework for measuring health and disability at both individual and population levels. To me it represented a most useful nursing theory. The focus was on a human being’s ability, influenced by her/his health condition, as well as personal and environmental factors. The person’s ability/activity is influenced by, and influences body structures/functions, as well as the ability to participate in social and work life.

ICF was officially endorsed by all 191 WHO Member States in the Fifty-fourth World Health Assembly on 22 May 2001(resolution WHA 54.21) as the international standard to describe and measure health and disability. For me it was the endorsement of a comprehensive nursing theory in combination with my model.

References

International classification of functioning, disability, and health: ICF. (2001). World Health Organization, Geneva

Pflegekontinuum nach Hirschfeld. Siebentes Münsterlinger Pflegesymposium, Münsterlingen, 23.09.2005

About Miriam Hirschfeld

from https://www.rozana.org/miriam-hirschfeld

Miriam Hirschfeld graduated from a Diploma program in Vienna, Austria before she immigrated to Israel in 1965. Her B.A. is from Tel-Aviv University and her Master’s of Science and her Doctor of Nursing Science degrees are from the University of California San Francisco. After working as a staff nurse and clinical instructor in cardiac care, neurosurgery, oncology and psychiatry she taught at Tel-Aviv University, where she became the director of the first generic nursing program, while being responsible for the development of geriatric and long-term care for the Clallit Sick Fund. In 1989 she was selected as the Chief Scientist for Nursing of the World Health Organization (WHO) in Geneva and held this position for nine years, when she was nominated (as the first nurse) Director of Human Resources for Health. After becoming Acting Director of Health Systems, she established a new WHO Initiative on Long term care. Upon retirement from WHO, she returned to Israel in 2003, where she joined the faculty of the Emek Yezreel College, as Professor in the Department of Health Systems Management, and in 2007 she established the academic nursing program, which she headed until 2013. Her interests range from long-term care, multi-cultural nursing education and health workforce policy to ethics and human rights, as well as the impact of globalization upon health.

She is a member of the Nurses in the Middle East Steering committee and the Israeli-Palestinian Midwives Group, as well as the Israel Nursing Ethics Bureau Research committee, active in ongoing ethics research. From 2017-2025 she was a board member of the Physicians for Human Rights, Israel. She has a considerable list of publications and held Workshops for Palestinian and Israeli nurses on solving common problems in their daily practice. The University of Nottingham awarded her an honorary medical degree and the Oregon Health Sciences University an honorary doctorate in science. The President of Austria awarded her the highest Award of the Republic for her contribution to nursing development and in 2022 she received the Princess Srinagarindra Award in recognition of a lifelong career in advancement of nursing, ethics and human rights. (from https://www.rozana.org/miriam-hirschfeld)

See also Dr. Hirschfeld’s contribution to Marsha Fowler’s book: Nursing Ethics, 1880s to the Present