1.

1 History of Nursing Theory

 Nursing profession immensely and progressively evolved along with the transition in nursing
theories.
 The onset of nursing theory development can be traced back to Florence Nightingale in 19 th
Century.
 In the second half of the 20th Century, nursing theory transformed nursing as a discipline.
 To establish nursing as an academic discipline and profession, it requires:
1. Nursing Theory – body of knowledge to guide nursing practice
2. Theory Development – to develop a body of substantive knowledge to guide nursing
practice.
 In the 21st Century, nursing theories guide critical thinking in the practice of nursing. Nursing
theories provide the nurse with:
1. Patient focus and framework to sort patient data in practice.
2. Guide both thinking and nursing action.
 It is recognized that theory informs practice and also that practice informs theory.
 “The systematic accumulation of knowledge is essential to progress in any profession…however,
theory without practice is empty and practice without theory is blind”(Cross, 1982)
 Overall, nursing theory is the backbone of clinical care.

1.2 Highlights of the Significant Events in History of Nursing Theory

 Florence Nightingale (1859-1992)
- Nightingale’s “Notes on Nursing” outlines the functions/role of nurses and presents the very first
nursing theory that focuses on environmental manipulation.
 The Columbia School --- The 1950s
- Recognized the need to prepare nurses at the graduate level for administrative and faculty
positions.
- Columbia University’s Teacher College developed the graduate education programs for nurses.
 The Yale School ---The 1960s
- Focus of theoretical thinking in nursing shifted from a problem/need and functional role to
relationship between nurses and the patient.
- Yale school’s theoretical position was influenced by the Columbia Teacher’s College graduates
who became faculty members there.
- Federal funds were made available for doctoral study for nurse educators.
 The 1970s
- Many nursing theories were first presented and most of these theories have been revised since
their original presentation.
 The 1980s
- Many nursing theories were revised based on the research findings that expanded them.
 The 1990s
- Numerous research studies that tested and expanded nursing theories existed.
- “Nursing Science Quarterly” edited by Rosemarie Rizzo Parse, is devoted exclusively to the
presentation of nursing theory – based research findings and theoretical topics.
- Martha Rogers published her revised theory “Nursing: Science of Unitary, Irreducible Human
Beings.”

1.3 Eras of Nursing Knowledge

 Early in the 20th Century, nurses saw the need and begun to transition from vocation to profession.
 One criterion for the consideration of nursing as a profession – nursing practice must be guided by
a body of specialized knowledge.

 Curriculum Era (1900-1940s)

- Emphasis on curricular content and standardized curricula.
- Expansion of curricula beyond physiology and pathophysiology to social sciences, pharmacology,
and nursing procedures – taught in classes called “fundamentals” which means “basic element.”
- Differences between medical view and nurse view of a patient are visible as Nightingale (1996)
emphasized. Nursing beg to embrace science I the curricula.
 - Nursing procedures were taught and practice in ward-like room called “nursing arts” laboratory
and referred to as “skills lab” when nursing curricula emphasized science and research.
- Reference to the “art of nursing” was changed to the “science of nursing”, thus, the “ art and
science” in nursing is more supported in the present times.

 Research Era (1950-1970s)

- Emphasizes the role of nurses and what to research.
- Nurses were introduce to research – saw the need for nursing research
- Research became the driving force which led nurses to conduct research and to begin developing
the specialized body of knowledge.
- Many believed that research alone was what was needed to generate the body of knowledge or
science as basis for nursing practice.
- Emphasized scholarship and the need to disseminate research findings in scholarly publications.
- Isolated studies do not yield unified knowledge.

 Graduate Era (1950-1970s)

- Overlaps with research era.
- Focuses graduate education on knowledge development.
- Emphasis is carving out advance role and basis for nursing practice.
- Master’s degree program was offered – it includes courses in nursing research, clinical specialty
practice and leadership.
- Nurses also started to advance the doctorate programs from a wide range of related disciplines in
preparation for research and teaching roles in nursing.
- Conferences emerge and brought nurse together to exchange ideas.
- Research continued to develop in this era, theorists began publishing their nursing framework in
recognition of the need for nursing theoretical approach.
- Theoretical works of nurse scholars were recognized as frameworks for research and practice.

 Theory Era (1980-1990s)

- Strong emphasis on development started in this era.
- Phenomenal growth in nursing theory development (cornerstone of the development of the
nursing discipline).
- Theory era and research era led to scientific process which is important in the production of
scientific products.
- Growth in this era is manifested by the proliferation of nursing literatures and new nursing
journals, conferences both national and international, opening of new nursing doctoral programs.
- Metaparadigm (person, environment, health, nursing) understanding of nursing knowledge
(Fawcett) based on Kuhn’s idea.
- Fawcett’s proposal led to the understanding of middle-range or practice theory.
- Nursing theory is connected to or is derived from the models of nursing.

 Theory Utilization Era (21st Century)

- Referred to as Theory – based nursing practice
- New era of utilizing philosophies, models, or theories in practice of nursing
- Shift from theory development to theory application and utilization.
- Saw the importance of framework for critical – thinking and decision – making in professional
nursing practice.

 “Critical – thinking”
- “intellectually disciplined process of actively and skillfully conceptualizing, applying, analyzing,
synthesizing, and/or evaluating information gathered from, or generated by, observation,
experience, reflection, reasoning, or communication, as a guide to belief and action.”

The Future
 Meleis (1992) predicted six characteristics of nursing discipline that would direct theory
development in 21st Century and are still valid today.
 1. The human science underlying the discipline that “is predicated on understanding the
meanings of daily lived experiences as they are perceived by the members or the participants of
the science”
2. There is increased emphasis on the practice – orientation, or actual rather than “ought-to-be”
practice.
3. Nursing’s mission is to develop theories to empower nurses, the discipline, and clients.
4. “Acceptance of the fact that women may have different strategies and approaches to
knowledge development than men.”
5. Nursing’s attempt to “understand consumers” experiences for the purpose of empowering
them to receive optimum care and to maintain optimum health.
6. “The effort to broaden nursing’s perspective includes efforts to understand the practice of
nursing in third world countries.”
 Meleis (1992) forecasts that nursing theories will become theories for health, developed by nurses,
physicians, therapists, and others.

1.4 Significance of Nursing Theory

 The greatest significance of nursing theory is that, nursing was recognized as an academic
discipline and a profession.

The Meaning of Discipline versus a Profession

 A discipline is specific to academia and refers to a branch of education, a department of learning, or
a domain of knowledge.
 A profession refers to a specialized field of practice founded on the theoretical structure of the
science or knowledge of the discipline and accompanying practice abilities.

Significance of Nursing Theory for the Discipline

 The discipline is dependent on theory for its continued existence – that is, nursing can be a
vocation, or nursing can be a discipline with a professional style of theory – based practice.
 The theoretical works have taken nursing to higher levels of education and practice.
 Knowledge of persons, health, and environment forms the basis for recognition of nursing as a
discipline, and this knowledge is taught to those who enter the profession.

Significance of Nursing Theory for the Profession

 As nursing theory is essential for the existence of nursing as an academic discipline it is also vital to
the practice of professional nursing (Mc Crae, 2012)
 Nursing is recognized as profession today because its development was guided by the criteria for a
profession as published by Bixler and Bixler(1959)
 The application of nursing knowledge in the practice is the criterion for profession that is currently
at the forefront, with emphasize on quality, accountability, theory – based or informed evidence
and recognition of middle – range theory for professional nursing practice (Alligood,2014)
 The commitment to theory – based evidence for practice is beneficial to patients in that it guides
systematic, knowledgeable care.
 The continued recognition of nursing theory as a tool for reasoning, critical thinking, and decision –
making is required for quality nursing practice.
 The use of theory amplifies knowledge development and enhances the quality of nursing practice.

Criteria for Development of the Professional Status of Nursing

1. Utilizes in its practice a well – defined and well – organized body of specialized knowledge (that is
on the intellectual level of higher learning).
2. Constantly enlarges the body of knowledge it uses and improves its techniques of education and
service through the use of the scientific method.
3. Entrusts the education of its practitioners to institutions of higher education.
4. Applies its body of knowledge in practical services vital to human and social welfare.
5. Functions autonomously in the formation of professional policy and thereby in the control of
professional activity.
6. Attracts individuals with intellectual and personal qualities of exalting service above personal gain
who recognize their chosen occupation as a life work.
7. Strives to compensate its practitioners by providing freedom of action, opportunity for continuous
professional growth and economic security.