A.
Introduction to Nursing Theory
History of Nursing Theory
Florence Nightingale began the history of nursing. At a moment when
females were neither trained nor employed in public service, Florence
Nightingale expected nurses as a body of trained females. After her war-time
service of organizing and caring for the wounded in Scutari during the Crimean
War, Nightingale’s vision and establishment of School of Nursing at St. Thomas’
Hospital in London marked the birth of modern nursing. Nightingale’s pioneering
activities in nursing practice and education and her subsequent writings became
a guide for establishing nursing schools and hospitals in the United States at the
beginning of the 20th century. Nightingale’s vision of nursing has been practiced
for more than a century, and theory development in nursing has evolved rapidly
over past 6 decades, leading to the recognition of nursing as an academic
discipline with a specialized body of knowledge. It was during the mid-1800s that
Nightingale recognized the unique focus of nursing and declared nursing
knowledge as distinct from medical knowledge. She described a nurse’s proper
function as putting the patient in the best condition for nature (God) to act upon
him or her. She set forth the following: that care for the sick is based on
knowledge of persons and their surroundings—a different knowledge base than
that used by physicians in their practice. Despite this early edict from Nightingale
in the 1850s, it was 100 years later, during the 1950s, when nursing profession
leaders began serious discussion of the need to develop nursing knowledge
continued to grow. Until the proposal of nursing as a science in the 1950s,
nursing practice was based on principles and traditions that were handed down
through an apprenticeship model of education and individual hospital procedure
manuals. Although some nursing leaders aspired for nursing to be recognized as
a profession and become an academic discipline, nursing practice reflected its
vocational heritage more than its professional vison. Nurses began with a strong
emphasis on practice, and work throughout the century toward the development
of nursing as a profession.
The transition from vocation to profession is described in successive eras
of history as nurses began developing a body of specialized knowledge on which
to base nursing practice.
Curriculum Era (1900-1940s) – addressed the question of what content
nurses should study to learn how to be a nurse. During this era, the emphasis
was on what courses nursing students should take, with the goal of arriving at a
standardized curriculum. The curriculum era emphasized course selection and
content for nursing programs and gave way to the research era.
Research Era (1950-1970s) - which focused on the research process and
the long-range goal of acquiring substantive knowledge to guide nursing practice.
Nurse leaders embraced higher education and arrived at an understanding of the
scientific age and that research was the path to a new nursing knowledge.
Nurses began to participate in research, and research courses were included in
nursing curricula in early graduate nursing programs.
Graduate education Era (1950-1970’s) - Master’s degree programs in
nursing emerged across the country to meet the public need for nurses for
specialized clinical nursing practice. Many of these graduate programs included a
course that introduced the student to the research process. Also during this era,
nursing master’s programs began to include courses in concept development
and nursing models, introducing students to early nursing theorists and
knowledge development process. Major force at this time was the development
of nursing knowledge. The research era and the graduate education era
developed in tandem.
Theory Era (1980-1990s) – Natural outgrowth of the research and
graduate education eras. As understanding of research and knowledge
development increased, it became obvious that research without conceptual and
theoretical frameworks produced isolated information rather than a body of
nursing knowledge. The theory era accelerated as early works developed as
frameworks for curricula and advanced practice guides began to be recognized
as theory. The 1980s was a period of major developments in nursing theory that
has been characterized as a transition from the preparadigm to the paradigm
period in nursing.
Theory utilization Era (21st Century) – The accomplishments of normal
science accompanied the theory utilization era as emphasis shifted to theory
application in nursing practice, education, research and administration. In this
era, middle-range theory and the value of a nursing framework for thought and
action in nursing practiced was realized. The shift in emphasis to the application
of nursing theory was extremely important for theory-based nursing, evidence-
based practice, and future theory development.
Significance for the Discipline
University baccalaureate programs proliferated, masters programs
in nursing were developed, and the curricula began to be standardized
through the accreditation process. Attention to the importance of nursing
conceptualizations for the research process and the role of a conceptual
framework in the purpose and design of research production of science
and nursing theoretical works also began to publish. Works began to be
recognize for their theoretical nature, such as Henderson, Nightingale and
etc. New nursing doctoral programs were beginning to open and they
reopened the discussion of the nature of nursing science. This becomes
the first classic reference for nursing as discipline and for distinguishing
between the discipline and profession. Fawcett’s conceptualization of
metaparadigm of nursing and unifying conceptual-theoretical structure of
knowledge recognize works of major nursing theorist as conceptual
framework and paradigms of nursing.
Major significance is; the discipline is dependent upon theory
- Theoretical works have taken nursing to a higher level.
- The emphasis has shifted from a focus on knowledge about how nurses
function, which concentrated on the nursing process, to focus on what
nurses know and how they use knowledge to guide their thinking and
decision making while concentrating on the patient.
Significance for Profession
Clearly, nursing is recognize as a profession today.
Bixler and Bixler published a set of criteria tailored to nursing in the
American Journal of Nursing in 1959. They stated that a profession:
a. Utilizes in its practice a well-defined and well-organized body of specialized
knowledge that is on the intellectual level of the higher learning.
b. Constantly enlarges the body of knowledge it uses and improves its
techniques of education and service by the use of the scientific method.
c. Entrusts the education of its practitioners to institution of higher education.
d. Applies its body of knowledge in practical services that are vital to human and
social welfare.
e. Functions autonomously in the formulation of professional policy and in the
control of professional activity thereby.
f. Attracts individuals of intellectual and personal qualities who exalt service
above personal gain and who recognizes their chosen occupation as a life work.
g. Strives to compensate its practitioners by providing freedom of action,
opportunity for continuous professional growth and economic security.
These criteria have historical value because they provide an understanding of the
developmental path the nursing followed.
2. Nursing theory is a useful tool for reasoning, critical thinking, and decision
making in nursing practice.
3. Nursing theoretical works provide a perspective of the patient.
4. Nursing theory provides more direction for nursing practice.
5. The conceptual models of nursing are comprehensive and the reader to the
specifics of the practice.
6. Middle range theories contain the specifics of nursing
B. History and Philosophy of Science
Rationalism
Rationalism is the philosophy that knowledge comes from logic and a certain kind of
intuition—when we immediately know something to be true without deduction, such as “I
am conscious.” Rationalists hold that the best way to arrive at certain knowledge is
using the mind’s rational abilities. Rationalism is an idea about where knowledge comes
from, and is therefore part of the philosophical sub-field of epistemology.
Empricism
Empiricism is the philosophy of knowledge by observation. It holds that the best
way to gain knowledge is to see, hear, touch, or otherwise sense things directly. In
stronger versions, it holds that this is the only kind of knowledge that really counts.
Empiricism has been extremely important to the history of science, as various
thinkers over the centuries have proposed that all knowledge should be tested
empirically rather than just through thought-experiments or rational calculation.
Empiricism is an idea about how we know things, which means it belongs to the field
of epistemology.
“Rationalism and empiricism both play a role in science, though they correspond
to different branches of science. Rationalism corresponds to mathematical analysis,
whereas empiricism corresponds to experiments and observation.”
Early 20th Century Views
Emergent Views
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