Contributor: Julie Joseph, MSN,RN, CCRN
PhD Student, Texas Woman’s University, 2005

Author – Therese Connell Meehan, PhD (Nursing)

First Published – 2003

Major Concepts

The central concept of Careful Nursing is therapeutic presence within a safe, calm environment, through which nurses promote the dignity, protection, and flourishing of the person.
This central concept integrates three core ideas:

• Therapeutic Presence – the nurse’s intentional calm, attentiveness, compassion, and moral commitment to being fully present with the person.
• A Healing, Ordered Environment – creating and maintaining physical and emotional conditions that support safety, comfort, rest, and recovery.
• Support for Human Flourishing – caring for the whole person (physical, emotional, moral, and spiritual) to enable wellbeing and resilience.

Together, these form the foundational concept that guides all other elements of the Careful Nursing model.

Typology

Careful Nursing is most accurately characterized as a conceptual model of nursing. It is a contemporary Irish conceptual model of nursing grounded in the practices of 19th-century Irish nurses, notably the Sisters of Mercy and the Irish Sisters of Charity. Careful Nursing is now employed internationally by nurses and serves as the foundation for her extensive scholarly publications.It offers a structured, comprehensive framework that delineates the philosophical underpinnings, fundamental concepts, and practice processes that inform nursing care. Unlike a theory, which emphasizes testable propositions, or a practice framework, which provides solely operational guidance, Careful Nursing synthesizes historical, philosophical, and practical elements into a unified model. It explains how nurses perceive individuals, health, the nurse–patient relationship, and the professional obligations of nursing, all rooted in the unique 19th-century Irish nursing traditions of the Sisters of Mercy and the Irish Sisters of Charity. Through this conceptual model, Careful Nursing facilitates both practice and further theoretical advancement.

Description

Careful Nursing is a conceptual model grounded in the practice traditions of 19th-century Irish nurses, particularly the Sisters of Mercy and the Irish Sisters of Charity. It brings together philosophical, relational, and practice components that highlight nursing’s unique contribution to human wellbeing. Its central tenets include:

Philosophical Foundation in Human Flourishing

Careful Nursing is built on a strong philosophical orientation that views the human person as inherently dignified, relational, and oriented toward flourishing. Nurses support this flourishing by creating an environment that enables physical, emotional, moral, and spiritual wellbeing. This foundation emphasizes the moral nature of nursing and the nurse’s responsibility to foster conditions in which persons can thrive.

Therapeutic Use of Presence and Calm

Central to the model is the nurse’s therapeutic presence, expressed through attentiveness, calmness, compassion, and respectful engagement. This prsence creates a healing atmosphere that supports recovery and reduces fear, stress, and suffering. The model highlights the therapeutic value of quiet, steady, and reassuring interaction—an approach deeply rooted in the historical nursing practices on which Careful Nursing is based.

The Practice Process: Skilled Compassionate Care

Careful Nursing outlines a structured practice process that includes

• Establishing a healing environment that is orderly, safe, and comforting.
• Engaging in precise observation and clinical judgment, grounded in both scientific knowledge and attentive presence.
• Providing direct skilled care that meets physical needs with gentleness, expertise, and respect.
• Supporting emotional and spiritual needs, recognizing the whole person.
• Promoting rest and restorative activities, grounded in a historical understanding of recovery as a holistic process.

This process reflects the disciplined, meticulous approach observed in early Irish nursing systems.

Relational and Ethical Commitment

The model emphasizes the nurse–person relationship as a moral and therapeutic partnership. Nurses are called to exercise compassion, humility, respect, and moral courage in their interactions. Ethical responsibility is central, in which nurses are accountable for both the quality and integrity of their care and for advocating for those in vulnerable circumstances.

The Importance of Order, Safety, and Protection

Drawing on its historical roots, Careful Nursing stresses the importance of maintaining an orderly, structured environment that minimizes risk and supports safety. Order is seen not as rigidity but as a means of creating predictability, reducing anxiety, and fostering healing. This includes vigilant attention to preventing harm, such as falls, infections, or emotional distress.

Integration of Historical Wisdom With Contemporary Practice

A defining feature of Careful Nursing is its synthesis of historical nursing practice with modern nursing knowledge. It translates the disciplined practices of early Irish nurses into a contemporary model that can guide professional practice today. This integration positions Careful Nursing as both historically grounded and forward-looking.
In essence, Careful Nursing emphasizes therapeutic presence, ethical relational care, meticulous practice, and an environment conducive to human flourishing, which reflects a deeply holistic understanding of nursing.

Primary Sources

Meehan TC, Timmons F, Burke J. (2018) Fundamental care guided by the Careful Nursing Philosophy and Professional Practice Model©. Journal of Clinical Nursing, 27, 2260-2273

Meehan T.C. (2012) Spirituality and spiritual care from a Careful Nursing perspective. Journal of Nursing Management, 8, 990-1001.

Meehan, T. C. (2020). The careful nursing philosophy and professional practice model. carefulnursing. https://www.carefulnursing.ie

About Dr. Meehan

Dr. Therese Connell Meehan is a distinguished nurse scholar of international repute, recognized for her significant contributions to clinical research, nursing history, and the development of nursing theory. Originating from Southland, New Zealand, she received her foundational education at St Mary’s College in Wellington and commenced her nursing career as a nursing assistant at Mater Misericordiae Hospital in Auckland. She completed her general and obstetrical nursing training at the Auckland Hospital School of Nursing, and subsequently spent four years traveling and practicing nursing in England, Italy, and various regions across Europe and the Middle East. In the early 1970s, Dr. Meehan relocated to the United States to pursue advanced education. She obtained her Bachelor of Nursing degree from the University of Pennsylvania in 1975, followed by a Master’s Degree in Nursing with a Minor in Education from New York University (NYU) in 1978, where she was honored with the Outstanding Master’s Student Award in 1977. Supported by a competitive doctoral scholarship, she completed her PhD in Nursing at NYU in 1984 while concurrently holding several positions in acute care clinical practice.

Upon completing her doctorate, Dr. Meehan assumed the role of Director of Nursing for Research at the New York University Medical Centre. During this tenure, she spearheaded influential clinical research studies investigating the effects of nurses’ therapeutic touch on postoperative pain, interventions to mitigate nurses’ stress, and risk factors for patient falls. Her research garnered over half a million dollars in funding from the U.S. National Institutes of Health and organizations such as Sigma Theta Tau International, the American Nurses Foundation, and the United Hospital Fund. In recognition of her contributions, she was designated one of the New York State Legislature’s Nurses of Distinction in 1990. Dr. Meehan relocated to Ireland in 1996, initially contributing to the Faculty of Nursing & Midwifery at the Royal College of Surgeons in Ireland before joining University College Dublin as a Senior Lecturer in Nursing.

In 2003, she led the inaugural national study of nursing and midwifery research priorities in Ireland, funded by the National Council for the Professional Development of Nursing and Midwifery through the Health Research Board. Her research focus in Ireland transitioned to historical scholarship, particularly the development of modern nursing in Ireland from 1800 to 1856. She has illuminated Ireland’s rich nursing heritage, including the early nursing system at Dublin’s Hardwick Fever Hospital and the contributions of skilled Irish nurses in the Crimean War. Her historical work has been recognized with Research Fellowships from the Nursing History Centres at the University of Virginia and the University of Pennsylvania.

Dr. Meehan is the creator of Careful Nursing, a contemporary Irish conceptual model of nursing grounded in the practices of 19th-century Irish nurses, notably the Sisters of Mercy and the Irish Sisters of Charity. Careful Nursing is now employed internationally by nurses and serves as the foundation for her extensive scholarly publications.