foumal of Advanced Nurstng,

1993,18,1651-1656

The discipline of nursing: historical roots,

current perspectives, future directions
Maureen C Shaw RN MN
Climcal Nurse Spectaltst, The Arthntis Society (BC and Yukon Divtston), 895 West 10th
Avenue, Vancouver, Bnttsh Columbia, W Z 717, Canada

Accepted (or publicahon 15 Febniary 1993

SHAW M C (1993) Journal of Advanced Nursing 1 8 , 1 6 5 1 - 1 6 5 6

The disapline of nursing: historical roots, current perspectives, future
directions
As advances m nursmg saence and research impact upon nursmg education and
climcal pradice, new ways of looking at phenomena have led to a re-exammation
and refmement of the traditional concepts person, environment, health and
nursmg This evolving pattem of mtellectual growth holds promise for the
disaplme of nursmg through the advancement of knowledge based upon
saentific mquiry mto the practice of nursing This paper discusses nursmg as a
disaplme by examinmg the development of a unique body of knowledge from
three viewpomts histoncal past, current perspectives and future direction

HISTORICAL ROOTS
The disaplme of nursing slowly evolved from the
tradihonal role of women, apprenticeship, humamtanan
aims, rehgious ideals, intuihon, common sense, tnal and
error, theones, and research, as well as the multiple
influences of mediane, technology, pobhcs, war, economics
and femmism (Jacobs & Huether 1978, Keller 1979, Brooks
& Kleme-Kracht 1983, Gorenberg 1983, Perry 1985, Kidd
& Momson 1988, Lynaugh & Fagin 1988)
The first nurse-theonst, Florence Nightmgale (1969),
viewed nursmg as havmg organized concepts and social
relevance distinct from mediane Later, Henderson (1965)
descnbed nursing as a umque, complex service with
mdependent practihoners who were authonhes on nursing
care
More recently, Roger's (1970) hohshc interpretations
of persons have become a cntical pomt of departure in
advanang theory by defining nursmg as an art and a
saence and by providing a substcintive base for theory
testmg
In a landmark paper, Donaldson & Crowley (1978)
define a disaplme as 'a umque perspechve, a dishnct way
of viewmg all phenomena, which ultimately defines the
limits and nature of its mquiry' Smxx the hme of Florence

Nightmgale, nurse-scholars have sought to explore, understand and explicate the concepts central to the domam of
nursing person, health, environment and nursmg Themes
delunitmg the boundary for nursmg practice and investigation include (a) laws and pnnaples govermng life
processes and well-bemg of humans, (b) influences of the
environment on human behaviour, (c) processes whereby
nursmg posihvely affeds health, and (d) families and
commumties as a focus of nursmg practice (Donaldson &
Crowley 1978, Fawcett 1984)
A recent review of the hterature suggests a consensus
on the recurrent themes and commonalities central to
nursing's domam of mquiry (Donaldson & Crowley 1978,
Ellis 1982, Bramwell 1985, Meleis 1987)

Hallmark of success
Consistency over time regarding the ldentifieation of the
boundary and domam of nursmg is not orJy a strength of
the discipline but also a hallmark of success m nursmg
research and theory development As such, it is time to
extend formal acceptance to the domain concepts and
boundanes as a paradigm germane to a disaplme of
nursmg
1651

MC Shaw
Currently, nurse educators, scholars, dmiaans and
researchers contmue to contnbute to the disaplme's
comerstone by danfymg the work and role of nursmg
in health care and advanang nursmg knowledge from a
state of haphazard, unvenfied thoughts to a disaplme of
systemahcally organized concepts (Table 1)
CURRENT PERSPECTIVES
Despite a growmg consensus on a nursmg paradigm, the
definihon of nursmg as a disaphne remams ambiguous
(Hardy 1978, Jacobs & Huether 1978, Meleis 1987,
Northrup 1992) Hardy (1978) bebeves dissent is charactenstic of nursmg's preparadigmahc stage of saenhfic
development where confusion and dispute over theory and
research are a normal developmental stage However,
Hardy's attempt to measure the performance of nursmg
agamst saenhfic advances germane to medical science has
resulted m a negahve, hnear estimate of nursmg as a disaplme and fculed to recognize nursing's unique contnbutions
to the health care of soaety
Moreover, nursing may not expenence penods of
normal saence, such as those outlined by Kuhn (1970), and
may conhnue to evolve indefinitely Rather than argumg
the disaplinary status of nursmg, the queshon, as posed
succmctly by Perry (1985), is 'Has the disaplme of nursmg
developed to the stage where nurses do "think nursmg'T
Numerous theones and conceptual models have been
advanced smce the 1960s in order to assist nurses to systranahcally thmk nursmg To Meleis (1987) theory is a
powerful, dynamic, yet focused, source of professional
autonomy and dmical knowledge Rather than a saentific
revolution or evoluhon, the development of nursmg
knowledge is an unconvenhonal, convoluted process
(Meleis 1985).
It could be argued that a straight road to a convenhonal
paradigm would mark nursmg's acceptance mto the saentific community However, the advancement of nursmg
theory cannot be measured m the same manner as the
physical, pharmacological, medical or psychological saences Smce nursing has adopted many competmg and
complementary theones (Meleis 1985), the debate on the
worthmess of these theones wiU conhnue to contnbute to
the scholarly development of nursing as a disaplme over
time
Scholarsfi-omHardy (1978) to Northrup (1992) have
advocated completmg theones and adophng a specific
paradigm m order to bnng consensus and cohesion to the
disaplme of nursmg On the other hand, recent authors
(Meleis 1987, Banett 1992) propose diversity and plurality
m nursmg philosophy, saence and practice From a dimcal
1652

perspective, not only is adoption of a specific perspechve

unlikely m a disaphne that understands mulhdimensional,
complex human behaviour, but theorehcal consensus is quite
unlikely m a disaplme that values the role of percephons,
uniqueness and individuality m health and illness
Smce nurse-theonsts have mdividual approaches
towards life, healthy differences of opmion will contmue
to exist and to fuel the scholarly debate in the future
regardmg nursmg's ontoiogical and epistemological aims
Indeed, nursing has now tumed to philosophy for assistance with appropnate strategies congruent with nursmg's
assumptions and missions (Meleis 1992)
Challenge to completed-theory perspective
Meleis (1987) challenges the perspechve that completed
theory is the only way to achieve disaplinary status and
that outcome is the sole validation of theory The endproduct 'the process of conceptualizmg a phenomenon,
the process of understanding a dimcal situation and the
process of going beyond the data m a research project'
(Meleis 1987) is the essence of theoretical development
Theones-m-process are not the mcomplete manifestahons
of an unsystematic, haphazard mquiry, they connect
nursing's ontological concems with the paradigm's domain
concepts
In knowledge development, theonzmg is not an orderly
progression of thought, but a process of cnhcal thinking
charged with difficulty and ambiguity Furthermore, this
scholarly process has lead to the formahon of the domam
concepts and ldentificahon of the boundanes of nursmg
which, in tum, have further coalesced mto a paradigm that
forms the base for the disaplme of nursmg as known today
The recent literature on canng illustrates how nursmg
scholars conhnue paradoxically to queshon the limits, yet
advance the boundanes, of a disaplme of nursmg Watson
(1988) developed the concept of canng as a central tenet
m her nursmg model Leuunger (1981) descnbes canng
as the unifymg domam for nursmg's body of knowledge
and prachces, while Swanson (1991) proposes carmg as a
theory of social process that is essenhal, but not unique to
nursing
Indeed, to many nursmg theonsts, canng provides an
essenhai, unifying lmk withm the paradigm concepts
(Barrett 1992) However, although carmg and health are
central to nursmg, an mtegrahng statement has not been
developed and the concepts cannot stand alone to meet the
cntena for the focus of the disaplme (Newman et al 1991)
Moreover, the addihon of carmg to the domam concepts
raises questions about the artifiaal and reductionistic
separahon of carmg, knowmg and domg withm nursmg's

The dtsapline of nursing

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MC Shaw
response to the human expenence of health Indeed, if
canng is cenfral to nursing, can knowing be separated from
doing withm the nurse-dient relahonship?
Perfiaps the disaplme's evolving perspechve and conceptualization of the phenomena will define whether canng
becomes incorporated mto the domam concepts or remams
as a theory that substanhates nursmg's profound ability to
assist dients to find meanmg m the expenence of health
and illness

totahty paradigm approach to theory development has

added fuel to the debate
Theonsts in the simultaneity paradigm (Rogers 1970,
Parse 1981, Newman 1986) advocate the theory 'of nursing view expliatly and call for theory development that is
concemed with imitary, irreducible human beings and their
environments
In the totality paradigm, theonsts such as Roy (1984)
and Orem (1985) advance the theory 'for' nursmg view and
call for the development of specialty-focused theory for
dimcal populations Yet, knowledge advanced withm one
An art with humanitarian aims
theorehcal perspechve does not belong to a speafic paraDespite extensive literature on theoretical development digm If discovery conferred ownership, then knowledge
(Meleis 1992, Mitchell 1992, Randall 1992, Ray 1992), the generated from von Bertalanfify's General Systems Theory
disaplme of nursmg is a philosophy of persons and their and Selye's theory of sfress would be unavailable to the
health expenences, that is, nursmg is also an art with disaplme of nursmg
humamtanan aims Benner (1984) descnbes excellence m
dimcal prachce based on perceptual awareness, sensihvity
Practice discipline
and cogmhve skills The unique synthesis of the art of
canng and the empinasm of saence distmguishes nursing Despite their apparent polanty, these theorehcal perspecfrom other health professions As such, the development of hves are not m opposition if nursmg is conceptualized as a
disaplme-specific perceptual and conceptual skills provides practice disaplme with a mandate from soaety to enhance
one way of mamtainmg a imique nursmg focus Thus, a the health and well-being of humaruty Surely, the goal of
franscending philosophical perspechve, rather than a nursmg theory is to contnbute to the wealth of knowledge
specific methodology, is charadenshc of the disaplme of required for dmical practice in a vanety of settmgs When
nursmg
practihoners, scholars and researchers achvely engage m
However, perception can contnbute towards static creatmg dynamic and workable soluhons to dmical and
behefs regardmg the uneasy, sometimes dichotomous, re- empincal problems of significance to the health of soaety,
lahonship between nursmg theory, prachce and research then mtegrahon of theory, research and practice may
Some authors believe theory is developed from research become a reality Indeed, the upcoming era of theory
based on dimcal prachce (Engsfrom 1984, Bramwell 1985), development and refinement from a nch tapestry of theorwhile others advocate the advent of pure saence without etical perspechves and research methodologies may fulfil
immediate relevance to prachce (Donaldson & Crowley nursmg's quest for ldenhty and self-acceptance as a prachce
1978, Bohny 1980)
disaplme
This debate is made more complex and polanzed by the
recent references m nursmg hterature to the purposes of
FUTURE DIRECTIONS
theory development Is theory 'of nursmg or 'for' nursmg?
According to Barrett (I99I), the issue is whether or not In response to the challenge of humanism and the holistic
nursmg is viewed pnmanly as a basic or an applied saence health care movement, nursmg research is more directed
As a basic saence, theory, research and practice focus on towards enhanang the understanding of dients and their
knowmg what is umque to nursmg On the other hand, as environments Genmngs 1986) Furthermore, Fawcett
an applied saence, the focus of the disciplme is on the (1984) beheves that empinasm may be mcompatible with
practice of nursing
nursmg's humamshc and holistic aims
However, queshons about knowing and doing in
The nursing literature is replete with papers outhnmg
nursmg are another twist to the debate regardmg theory the worth of objechve and subjechve methodologies to the
development that has been simmermg in the literature for disaplme To Maturana & Varela (1988) the soluhon to
the past 35 years Differences m these posihons have their this paradox is to move away from the opposihon, and to
roots m the debate concemmg unique versus borrowed change the nature of the queshon m order to embrace a
knowledge as the comerstone of the disaplme of nursing broader context, that is to walk the razor's edge If the
(Barrett 1991) Rather than danfymg the issue, the more disapluK of nursmg is dedicated to excellence of care
recent confroversy regarding the simultaneity vereus the through the advancemoit of knowledge, then to reject
1654

The dtsapltne of nursing

quantitahve research methods due to fear of dehumanizing

patients with redudionist methods would be an epistemological error
Both mduchve and deduchve methods are valid methods
of furthermg nursmg knowledge Moreover, development
and refinement of the substanhve body of knowledge can
address dmical concems and ultimately enhance care of
clients m numerous speciality areas of nursmg pradice
While research is essenhal to the development of nursing
knowledge, educahon of prachtioners withm a nursing
perspedive is of vital importance Structuring educahon
around a nursing paradigm, rather than tradihonal medical
dassiAcahon of disease, would aid m the socializahon
process of novices and encourage nurses to think nursmg
However, nursmg m North Amenca is the only health
care disaplme with diverse entry routes Smce educahonal
constramts may prevent nurses from usmg theorehcal
knowledge, further educahon at the baccalaureate, master's
and doctoral levels may equahze some of the power
struggles withm heeilth care, enhance the credibility of the
disaplme of nursing, and improve the ability of practitioners to test, evaluate and utilize theoretical knowledge
Society and the consumer
Soaal relevance and value onentahon defme the discipline
of nursing as much as empmcal knowledge (Donaldson &
Crowley 1978) As such, soaety can be a powerful ally in
the pursuit of nursmg knowledge Therefore, consultation
with the consumer regardmg goals and diredion for nursmg research, theory development and dient-centred models
of care is essential if the disaplme is to mamtam its humamtanan aims Indeed, soaety's self-help movement represents
the trend towards self-care and a shift towards greater client
autonomy and self-determination m health care
As nursing approaches the twenty-first century, nursmg
theory development must consider the changmg needs of
dmical populahons Alliance with the health care consumer
will ultimately benefit the disaplme of nursing by openmg
up new avenues for theory development and nursing
research
Moreover, nursing's quest for autonomy and accountability can be synthesized with the trend towards establishmg and maintaining optimal dient outcomes m health
care It is anhapated that the present emphasis on dient
outcomes and programme evaluation will enhance the
future development of nursing knowledge by utilizing
theones and methodologies developed m nursmg and
other disaphnes
Nursing has become mcreasmgly explicit m defmmg the
nature of its domam m a multitude of prachce areas For

example, a cnhcal appraisal of the application of theory,

developed withm nursing and other disaplmes, to a vanety
of settings where nursing is prachsed is now becommg
evident m the nursmg administration literature (Henry et al
1989, Lutjens 1992) As such, with the increase m a substantive knowledge base and vabdation and refinement of
theones through multiple modes of mquiry, a pluralism of
theones is emerging (Fawcett 1984)
Nursing can no longer ignore the challenge to define
the disaplme m terms of knowledge based upon nursmg
theory and to appraise knowledge from other disaphnes
for utility withm nursmg This cannot be done from the
ivory towers of academia, admimstration or pradice without consideration of the perspedive of the health care
consumer Commumcahon through debate and constructive feedback is not only essential to define and refine a
nursing paradigm, but also to extend the boundanes of
nursmg mto the unexplored temtory of the twenty-first
century

CONCLUSION
In order to chart a course mto the future, a discipline
of nursmg must encompass a proachve approach to the
development of theory that not only arcumnavigates the
present debates, but also bridges the worlds of research,
theory and practice
Advanang a disaplme of nursmg is complex, convoluted
and dynamic process The next century will provide nursing
vnih an opportumty to think nursmg, that is, nursmg will
treinscend the philosophy and knowledge of the disaplme
beyond the present boundanes
As Cicero (cited m Nulle 1980) wrote m 52 BC, 'reason
enables us to draw inferences, to prove and disprove, to
discuss and solve problems, and to come to conclusions'
Surely, this Roman scholar has provided a modem mandate
for a disaplme of nursmg

Acknowledgements
The author wishes to thank Dr M Munro RN PhD, Dean,
Faculty of Nursmg, Umversity of Pnnce Edward Island,
Charlottetown, Pnnce Edward Island, and Ms Bev Hills RN
MS, Manager of Nursmg and Laboratory, Arthntis Soaety
(BC & Yukon Division) for their support and helpful
comments on earlier drafts of this paper
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1655

MC Shaw
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