Strengths-Based Nursing (SBN) represents a fundamental shift in healthcare philosophy, moving from a problem-focused perspective to one that recognizes and builds upon the inherent strengths of individuals, families, and communities. Originating from the work of Dr. Laurie Gottlieb and her team at McGill University, the SBN framework is a value-driven approach that guides nursing action in caring for others. By focusing on what is working well, rather than just what is wrong, SBN empowers patients, fosters resilience, and promotes a more hopeful and effective healing process. Its roots can be traced back to Florence Nightingale's emphasis on creating healing environments, a concept re-conceptualized to fit the complexities of 21st-century healthcare.
The Eight Pillars of Strengths-Based Nursing
At the core of the SBN framework are eight interrelated values that provide the philosophical foundation for practice. These values serve as a compass, guiding nurses to observe, understand, and act in ways that are deeply responsive to the person in their care.
1. Health and Healing
Health is not merely the absence of disease; it's a state of wholeness that coexists with illness. This value emphasizes promoting the patient's capacity to adapt, rally from setbacks, and find purpose amidst challenges. Healing involves restoring wholeness and finding new equilibriums, a process nurses facilitate by creating supportive environments that bolster innate healing mechanisms.
2. Uniqueness
Each person is genetically, experientially, and culturally unique, and their health journey is personal. SBN recognizes that effective and compassionate care depends on understanding and appreciating this individuality. By uncovering a patient's particular disposition and how they respond to their environment, nurses can tailor care to be more personalized and effective.
3. Holism and Embodiment
This value treats the individual as an integrated whole, acknowledging the interconnectedness of their mind, body, and spirit. Illness is seen as a signal of dis-ease within the whole system, not just an isolated physical problem. An SBN nurse addresses all aspects of a person's being, understanding that the physical body is the vessel through which all experience is processed.
4. Subjective Reality and Created Meaning
People make sense of their health experiences by creating narratives based on their perceptions, emotions, and personal beliefs. This "subjective reality" is a powerful force that influences a person's responses and healing process. An SBN nurse actively listens to these narratives to understand the patient's perspective, empowering them to find or create meaning in their situation.
5. Self-Determination
Self-determination is about a person's right to make choices and feel in control of their health. Nurses empower patients by providing information, clarifying options, and connecting them with resources, enabling them to find their own voice and agency. The nurse’s role is not to decide for the patient, but to support and advocate for their informed decisions, respecting their self-knowledge.
6. Person-Environment are Integral
The relationship between a person and their environment is constant and influential. A person's physical surroundings, relationships, and broader cultural or economic factors all impact their ability to thrive. Nurses practicing SBN recognize this connection, striving to create environments that provide a "goodness-of-fit" for the patient's specific needs, values, and strengths.
7. Learning, Readiness, and Timing
Learning is fundamental to growth and change, but it requires readiness and proper timing. An SBN nurse must be attuned to the patient's readiness to engage in new activities or accept new information. By synchronizing interventions with the patient's capability and willingness, nurses can maximize the chances of successful learning and promote lasting, positive changes.
8. Collaborative Partnership
The nurse-patient relationship is not a hierarchy, but a collaborative partnership where power is shared. Both the nurse and the patient bring unique expertise to the relationship—the nurse with clinical knowledge, and the patient with lived experience. This mutual respect and collaboration encourage greater engagement and better outcomes.
Strengths-Based vs. Deficit-Based Nursing
The table below contrasts the SBN framework with a traditional deficit-based model to highlight the key differences in approach and philosophy.
| Aspect | Deficit-Based Nursing | Strengths-Based Nursing |
|---|---|---|
| Primary Focus | Identifying and fixing problems, weaknesses, and limitations. | Uncovering and leveraging inner and outer strengths, capabilities, and resources. |
| Patient's Role | Passive recipient of care; the focus is on their pathology. | Active participant and partner in their health and healing journey. |
| Nurse's Role | Expert who provides treatment and manages problems for the patient. | Facilitator who works with the patient to promote health and healing. |
| Assessment | Concentrates on signs, symptoms, and disease processes. | Includes exploring patient narratives, experiences, and meaning-making. |
| Goal Setting | Driven by clinical diagnoses and deficit reduction. | Patient-led, focusing on personal outcomes and aspirations. |
| Outcomes | Often focused on symptom resolution and disease management. | Concentrates on empowerment, self-efficacy, and a sense of hope. |
Practical Application of SBN Values
Putting these values into practice transforms the delivery of care and the patient's experience. For instance, in a clinical setting, a nurse using an SBN approach will intentionally focus on a patient's capabilities. Instead of seeing a patient with a chronic illness as "weak," the nurse identifies and supports their resilience, coping strategies, and determination to manage their condition. This could involve asking about their hobbies or family support systems to leverage these as resources for healing.
Another example is empowering a patient to make choices (self-determination) regarding their care plan, even if the choices are limited. By explaining the reasons behind certain treatments and involving the patient in the decision-making process, the nurse fosters a sense of control and collaboration, which can significantly reduce a patient's stress and improve their psychological well-being. This relational aspect is foundational to building a trusting partnership, one of the eight core values.
For nurses seeking further reading on this transformative approach, the work of Dr. Laurie Gottlieb and her team at McGill University provides a comprehensive resource base. Her publications, including those in the American Journal of Nursing, offer a deeper dive into the philosophical underpinnings and practical implementation of SBN in various healthcare settings.
The Strengths-Based Nursing Experience
For both the patient and the nurse, adopting the SBN philosophy is a profoundly different experience. Patients feel respected, heard, and valued as a whole person, not just a set of symptoms. This increases their sense of agency, hope, and engagement in their own healing process. For nurses, SBN re-centers their practice on the humanistic aspects of care, fostering deeper, more meaningful relationships with patients and increasing professional satisfaction. The framework encourages nurses to be curious, reflective, and collaborative, viewing challenges as opportunities for growth and innovation. Ultimately, the 8 strength-based values of nursing serve to humanize healthcare, creating an environment where true health and healing can flourish for everyone involved.
Conclusion
The 8 strength-based values of nursing—health and healing, uniqueness, holism and embodiment, subjective reality and created meaning, self-determination, the integral person-environment, learning/readiness/timing, and collaborative partnership—form a powerful philosophical framework for modern nursing. By shifting the focus from deficits to inherent strengths, SBN empowers patients, enriches the nurse-patient relationship, and creates conditions for optimal healing and well-being. This approach reminds us that the art and science of nursing is not about fixing broken parts, but about creating an environment where individuals can draw on their deepest capacities to become whole again.
