WEEK 1

Lecture - Monday January 6 Required Readings

Review Course Outline Text: Alligood

What is Nursing Theory? - Chapter 1: Introduction to Nursing Theory: Its
Introduction: History and Significance
- Discuss the influence of history on the nursing - Chapter 3: History of Nursing Science
profession.
- Identify what makes nursing knowledge separate
and unique from other disciplines?

Chapter 1
Introduction to Nursing Theory: Its History and Significance
Intro:
- "Theory without practice is empty; practice without theory is blind."
- Nursing theory emerged in the late 20th century.
- Promoted global growth in quality care, literature, and education.
- Early Nursing focused on skills/tasks; lacked a unified knowledge base.
- 20th-century push to establish nursing as a profession.
- Needed a specialized knowledge base to improve care quality.
- Shift from vocational to professional.
- Theory vital for practice, education, research, and recognition.
History of Nursing Theory:
- Florence Nightingale:
➔ Pioneered modern nursing in the 1850s during the Crimean War.
➔ Established a School of Nursing at St. Thomas’ Hospital, London.
➔ Differentiated nursing knowledge from medical knowledge.
➔ Defined nursing as creating conditions for natural healing.
- Transition to Profession:
➔ Mid-1900s: Shift from apprenticeship to professional nursing education.
➔ 1950s: Focus on developing nursing-specific knowledge apart from medicine.
- Curriculum Era:
➔ Standardized nursing curricula introduced by the 1930s.
➔ Shifted nursing education to universities by mid-20th century.
- Research Era:
➔ Mid-20th century: Nurses began participating in research.
➔ Research courses integrated into nursing graduate programs.
- Theory Era:
➔ 1970s: Recognition of the need for theoretical frameworks in research.
➔ Emergence of doctoral programs emphasizing nursing theory.
➔ Introduction of metaparadigms: person, environment, health, nursing.
- Utilization Era:
➔ Late 20th century: Focus shifted to applying theories in practice, research, and
education.
➔ Middle-range theories emphasized for evidence-based practice.

- Impact:
 ➔ Theory development established nursing as an academic discipline.
➔ Nursing theory continues to guide education, research, and clinical practice.

Significance of Nursing Theory:

- Early 20th Century: Nursing was not recognized as an academic discipline or profession.
- Current Status: Nursing is now recognized as both an academic discipline and a profession
due to progress over the past century.
- Discipline: A branch of knowledge studied and researched in higher education.
- Profession: A specialized field of practice based on theoretical knowledge and skills from the
related discipline.
- Relevance of Nursing Theory: Essential to establish nursing as both a discipline and a
profession.
Significance for the Discipline:
- Mid-20th Century Progress:
➔ Nurses entered university programs; knowledge for practice began developing.
➔ Standardized curricula were established through accreditation.
- 1970s Developments:
➔ Emphasis on conceptual frameworks in research and theory development.
➔ Theoretical works began addressing calls for nursing knowledge.
➔ Fawcett’s double helix metaphor clarified theory-research relationships.
- Recognition of Theorists:
➔ Early theorists like Henderson, Nightingale, and Peplau influenced nursing practice
frameworks and curricula.
➔ Conferences (e.g., 1978 Nurse Educator Nursing Theory Conference) highlighted
theorists and significance of theory.
- Keynote Address (Donaldson & Crowley, 1978):
➔ Called for both basic and applied research to advance nursing.
➔ Stressed the need to distinguish discipline (knowledge) from profession (practice).
- Metaparadigm Creation:
➔ Fawcett (1984) organized nursing concepts into person, environment, health, and
nursing.
➔ Unified theoretical frameworks elevated nursing knowledge and education.
- Discipline’s Survival on Theory:
➔ Theory enables nursing to move beyond vocational focus to professional knowledge-
based practice.
➔ Provides a patient-centered perspective essential for professional service.
 - Educational Implications:
➔ Master's and DNP (doctor of nursing practice) students apply theory in practice; PhD
students develop and test nursing theories.
➔ Kuhn’s philosophy highlights paradigms as essential for professional growth and
scientific development.
Significance for the Profession:
- Theory and Professional Nursing:
➔ Theory is vital for both academic discipline and professional practice.
➔ Nursing achieved professional status through theory-based progress in the 20th
century.
- Criteria for Professional Status (Bixler & Bixler, 1959):
1. Uses a well-organized, specialized knowledge base at a higher learning level.
2. Expands knowledge and improves education and services through scientific methods.
3. Relies on higher education institutions for practitioner training.
4. Applies knowledge to essential human and social welfare services.
5. Maintains autonomy in professional policy-making and activities.
6. Attracts individuals dedicated to service over personal gain, viewing nursing as a lifelong
vocation.
7. Ensures practitioners have freedom, growth opportunities, and economic security.
- Role of Nursing Theory:
➔ Theory-based evidence supports decision-making and systematic patient care.
➔ Guides data processing, evaluation of evidence, and practice decisions.
➔ Promotes patient-centered care and enhances professional recognition.
- Global Use of Nursing Theory:
➔ Nursing philosophies, models, and theories widely used in education, practice,
research, and administration.
➔ Theories are published globally, fostering international collaboration and application.
- Impact on Evidence-Based Practice:
➔ Theory-based research contributes to evidence-based nursing practice.
➔ Enables articulation of nursing's contributions within multidisciplinary teams.
- COVID-19 Pandemic Example:
➔ Highlighted the significance of professional nursing and theory-based care.
- Education and Knowledge Development:
➔ Increased emphasis on higher education for nurses and understanding nursing theory.
➔ Theories amplify knowledge development, improving the quality of nursing care.
Summary:
- Nursing theoretical knowledge is essential for professional practice, critical thinking, and
decision-making.
- Theory-based evidence improves care quality and enables nurses to process patient data, take
action, and evaluate outcomes efficiently.
- Theoretical frameworks support nursing participation in interdisciplinary care.
- Theory-based education enhances students' analytical and critical thinking skills.
- Nursing theory guides education, practice, research, and administration.
- Historical achievements in nursing science were pivotal but faced challenges, driven by
pioneering nurses who innovated for better health and nursing development.
- The volume of nursing theoretical works has grown significantly since the 1980s.
- Early nursing theorists, such as Peplau, Henderson, and Abdellah, laid the foundation for
systematic nursing knowledge, vital to the discipline's future.
Chapter 3
History of Nursing Science
Intro:
- Philosophy involves questioning fundamental concepts like reality (ontology), knowledge
(epistemology), justice (ethics), and the art of caring (aesthetics).
- Science describes, explains, and predicts causes or outcomes of interventions, guiding
evidence-based nursing practice.
- Scientific activity identifies causes, effects, and intervention impacts to improve health
outcomes and life expectancy.
- Since the 1960s, nursing leaders have worked to establish nursing as a scientific discipline
with unique knowledge for patient care.
- Nurses conduct clinical and basic research to build a scientific foundation for care across
individuals, families, and communities.
- Example: Preoperative mobility training reduced anxiety in total knee arthroplasty patients
(Iskender et al., 2020).
Historical Views of the Nature of Science:
- Formalizing nursing science requires exploring questions about science, knowledge, and
truth, influenced by philosophy.
- Philosophy shapes how researchers conduct and interpret scientific activities and define
science and knowledge.
- Two key philosophical perspectives in science:
1. Rationalism: Focuses on knowledge through reasoning (e.g., Pythagoras emphasized
mathematical reasoning).
2. Empiricism: Focuses on knowledge through sensory observation (e.g., Aristotle emphasized
systematic observation).
- Nursing science developed through two main philosophies:
➔ Empiricist/mechanistic: Quantitative, deductive methods.
➔ Interpretive/holistic: Qualitative, inductive methods.
- Both approaches contribute uniquely to nursing knowledge and practice.
Rationalism
- Rationalist epistemology emphasizes a priori reasoning, using deductive logic to advance
knowledge, e.g., linking social support to hospital readmission.
- This method uses causal reasoning and theoretical assertions that are tested experimentally.
- The theory-then-research strategy: Develop a theory, then test it; if results don't match,
modify or discard the theory.
- Popper argued that science advances by attempting to refute hypotheses rather than proving
them, e.g., testing medication’s effect on rehospitalization.
- Einstein's work is a prime example of rationalism, using mathematical equations to develop
and refine theories.
- The interplay between theory and empirical research refines and enhances the usefulness of
scientific theories.
Empiricism
- Empiricist view: Scientific knowledge comes from sensory experience (seeing, hearing,
feeling).
- Bacon's inductive method: Collect facts first, then make generalizations (research-then-
theory). Example: Formulating differential diagnoses by gathering facts first.
- Skinner's behaviorism: Emphasized collecting empirical data over theory-building; influenced
psychology's shift in the 1950s-1970s.
 - Inductive inquiry: Can face challenges in deciding what to observe, risking premature
conclusions.
- Deductive inquiry (theory-then-research) and inductive inquiry (research-then-theory) are
both used in nursing studies.
Early 20th Century Views of Science and Theory
- Early 20th century: Philosophers focused on theory structure, while scientists focused on
empirical research.
- Positivism: Dominant view of modern science, emphasizing empirical research and logical
analysis (deductive and inductive).
- Logical empiricism: Argued theoretical propositions must be tested through observation and
experimentation; objective truth exists independently of the researcher.
- Scientific method: Involves setting up experiments, observing, forming hypotheses, testing,
and modifying based on results.
- The rise of computers for data analysis helped solidify the positivist approach.
- By the 1950s, challenges to positivism led to a shift in scientific views in the late 20th
century.
Emergent Views of Science and Theory in the Late 20th Century
- In the late 20th century, philosophers like Foucault (1973), Kuhn (1962), and others
challenged positivism, focusing on the history and process of scientific discovery.
- Foucault argued that empirical knowledge is culturally and temporally patterned, with
humans emerging as study subjects.
- Brown (1977) proposed a shift in philosophy, emphasizing science as a continuous process of
building research, not just finding answers.
- Observations are influenced by the theories and values of the observer, as shown in the
example of an elderly patient with varying interpretations from different professionals.
- Three views of the relationship between theories and observation:
1. Scientists are passive observers of objective truth.
2. Theories structure what scientists perceive.
3. Theories and data interact in scientific investigation.
- Human pattern recognition is driven by both bottom-up (data-driven) and top-down
(conceptually driven) processes.
- Science is an ongoing process based on consensus among scientists, not final truths. Scientific
knowledge is based on available evidence and consensus at any given time.
- Science is structured by presuppositions, which guide what and how observations are made.
- Scientific revolutions occur when existing theories fail to explain new observations, leading
to paradigm shifts (Kuhn, 1970).
- Example: Nonsteroidal anti-inflammatory drugs (NSAIDs) shown to be as effective as
opioids for pain management (Chang et al., 2017).
Interdependence of Theory and Research
- Theory building and research are traditionally taught separately, causing students difficulty in
understanding their interdependence.
- Theory should be based on empirical findings and is subject to revision if it does not align
with new data.
- The acceptance of a theory should be based on scientific consensus, not authority or intuition.
- Science progresses collaboratively, with theories evaluated and built upon by the scientific
community.
- Theories must be repeatedly tested to gain consensus, with evidence accumulated over time.
 - If a theory is unsupported by research, it may not be rejected but questioned for the validity of
measures or research design.
- Consensus involves agreement on the theory’s boundaries, logic, and fit with research data.
- New theories may replace old ones if they better explain data or offer new research directions.
- In nursing, there is critique of traditional research methods, with a focus on context and
phenomenology to understand human experience holistically.
- Nursing knowledge now embraces post positivist and interpretive philosophies, focusing on
patterns, context, and social interactions.
- The postmodern paradigm challenges neoliberal views of healthcare as a profit-driven system,
advocating for social justice in nursing.
- The philosophy of nursing involves caring, holism, and naturalism, emphasizing
understanding the patient’s full experience and using ethical care.
- As nursing science evolves, more nurse scholars are contributing to the development of
knowledge through research and dialogue.
Science as a Social Enterprise
- Scientific inquiry is a social enterprise influenced by social, economic, and political factors.
- Science progresses through diverse dialogue within disciplines like nursing.
- Knowledge search today is shaped by political ideologies, funding systems, and healthcare
structures.
- Funding agencies prioritize data-driven empirical research, making it difficult for nurse
theorists to secure funding and limiting theoretical inquiry in nursing PhD programs.
- Non-European philosophies of science also influence nursing research.