Introduction to

Nursing Theory:

Its History and

Significance
 History of Nursing Theory
 History of professional nursing began with
Florence Nightingale.
 During 1950’s, nursing profession leaders began
serious discussion of the need to develop nursing
knowledge apart from medical knowledge to
guide nursing practice.
 Nursing as science were nursing practice was
based on principles and traditions that were
handed down through an apprenticeship model
of education and individual hospital procedure
manual.
 History of Nursing Theory
 Nursing practice reflected it’s vocational
heritage more than it’s professional vision.
 Nurses began developing a body of specialized
knowledge on which to base nursing practice.
 Nurses began with strong emphasis on
practice and worked throughout the century
toward the development of nursing as a
profession.
 Curriculum era
 Address the question of what content nurse
should study to learn how to be a nurse.
 Emphasis was on what courses nursing
students should take, with the goal of arriving
at a standardized curriculum
 Standardized curriculum had been published
in mid-1930’s and adopted by many diploma
nursing programs, where nursing was taught
at the time.
 Curriculum era
 The idea of moving nursing education from
hospital-based diploma programs into colleges
and universities began to emerge during this
era.
 Emphasized course selection and content for
nursing programs and gave way to the
research era.
 Research emphasis era
 Focused on the research process and the long-range
goal of acquiring substantive knowledge to guide
nursing practice.
 Nurses increasingly sought degrees in higher
education began to emerge.
 Nurses began to participate in research and research
courses were included in nursing curricula in early
graduate nursing program.
 In mid-1970s, an evaluation revealed that nursing
studies lacked conceptual connections and
theoretical frameworks, accentuating their necessity
for the development of specialized nursing
knowledge.
 Research emphasis era
 Awareness for the need of concept and theory
development coincided with two other
milestones in the evolution of nursing theory:
1. The standardization of curricula for nursing
master’s education by the National League for
Nursing accreditation criteria for baccalaureate
and high-degree programs.
2. The decision that doctoral education for nurses
should be in nursing.
 Graduate education era
 Developed in tandem with the research era.
 Master’s degree programs in nursing emerged
to meet the public need for specialized clinical
nursing practice.
 Included concepts in:
1. Concept development
2. Nursing models
3. Early nursing theorist
4. Knowledge development process
 Graduate education era
 Baccalaureate degree began to gain wider
acceptance as:
A. Educational level for professional nursing
B. Academic discipline in higher education
 Nurse researchers worked to develop and clarify
a specialized body of nursing knowledge with
the following goals:
A. Improving the quality of patient care
B. Providing a professional style of practice
C. Achieving recognition as a profession.
 Graduate education era
 Nursing continued to make transition from
vocation to profession.
 Nursing practice is to be based on nursing science
based on series of debates
 Meleis (2007) noted, “ theory is not a luxury in
the discipline of nursing...but an integral part of
the nursing lexicon in education, administration
and practice”
 Important precursor was the acceptance of
nursing as a profession and an academic
discipline in its own right.
 Theory era
 A natural outgrowth of the research and graduate
education eras.
 Research without conceptual and theoretical
frameworks produced isolated information rather
than a body of nursing knowledge.
 Doctoral education in nursing began to develop
with a strong emphasis on theory development
and testing.
 Accelerated as early works developed as
frameworks for curricula and advanced practice
guides began to be recognized as theory.
 Theory era
 1980s- was a period of major developments in
nursing theory that has been characterized as a
transition from the preparadigm to paradigm
period in nursing.
 Fawcett’s seminal proposal of four global nursing
concepts as a nursing metaparadigm served as an
organizing structure for existing nursing
frameworks and introduced a way of organizing
individual theoretical works in meaningful
structure.
 Theory era
 Classification of nursing models as paradigms
within metaparadigm concepts are ff:
a. Person
b. Environment
c. Health
d. Nursing
 The said classification united nursing
theoretical works for the discipline.
 Theory era
 The system clarified and improved
comprehension of knowledge development by
positioning the theorists’ works in a larger
context, thus greatly facilitating the growth of
nursing science.
 20th century- emphasis shifted from learning
about the theorist to use of the theoretical
works to generate:
a. Research questions
b. Guide practice
c. Organize curricula
 Theory era
 Kuhn’s (1970)-observations of nursing theory
development progress bring description of
normal science to life.
 His philosophy of science clarifies an understanding
of the evolution of nursing theory through paradigm
science.
 It is very important to understand that what we view
collectively today as nursing models and theories is
the work of individuals who originally published their
ideas and conceptualization of nursing around the
world.
 Theory era
 Theory development emerged as a process and
product of professional scholarship and growth
and sought higher education among:
1. Nurse leaders
2. Administrators
3. Educators
4. Practitioners
 These leaders recognized limitations of theory
from other disciplines to describe, explain or
predict nursing outcomes and they labored to
establish a scientific basis for nursing curricula,
practice, research and management.
 Nursing theory era
 The use of theory to convey an organizing
structure and meaning for these processes to
the convergence of ideas.
 Fitzpatrick and Whall (1983) had said,
“Nursing is on the brink of an exciting new
era”
 Theory utilization era
 Emphasis shifted to theory application in
nursing practice, research, education and
administration.
 Restored balance between research and
practice for knowledge development in the
discipline of nursing.
 Emphasis on the development and use of
nursing theory to produce evidence for
quality professional practice.
 Theory utilization era
 Types of nursing theoretical works:
1. Nursing philosophy
 Sets forth the meaning of nursing phenomena
through analysis, reasoning and logical presentation
 Contributed to knowledge development by providing
directions or a basis for subsequent development
2. Nursing conceptual methods
 Comprises nursing works by the theorist who also are
referred to as pioneers in nursing
 Theory utilization era
 Types of nursing theoretical works:
3. Nursing Theory
 derived from nursing philosophies, conceptual
models or more abstract nursing theories, or from
works of other disciplines
 Developed from some conceptual framework and is
more specific than the framework
 Theories may be specific to a particular aspect or
setting of nursing practice.
 Theory utilization era
 Types of nursing theoretical works:
4. Middle Range Theory
 More specific focus and is more concrete than
nursing theory in its level of abstraction.
 More precise , with a focus on answering specific
nursing practice questions
 Address the specifics of nursing situations within the
perspective of the model or theory from which they
are derived.
 They specify each factor as:
a. The age group of the patient
b. The family situation
c. The health condition
d. The location of the patient
e. The action of the nurse
 Theory utilization era
 Types of nursing theoretical works:
NURSING NURSING NURSING THEORIES MIDDLE RANGE
PHILOSOPHIES CONCEPTUAL NURSING THEORIS
MODELS
Nightingale Levine Boykin and Mercer
Watson Rogers Schoenhofer Mishel
Ray Orem Meleis Reed
Benner King Pender Wiener and Dodd
Martinsen Neuman Leininger Eakes, Burke and
Erikson Roy Parse Hainsworth
Johnson Erikson, Tomlin and Barker
Swain Kalkaba
Husted and Husted Beck
Swanson
Ruland and Moore
 Historical eras of nursing’s searcH for specialized knowledge

HISTORICAL MAJOR QUESTION EMPHASIS OUTCOMES EMERGING

ERA GOAL
Curriculum Era: What curriculum Courses Standardized Develop
1900-1940s content should included in curricula for specialized
student nurses nursing diploma knowledge and
study to be programs. programs. higher
nurses? education.
Research Era: What is the focus Role of Problem Isolated studies
1950-1970s for nursing nurses and studies and do not yield
research? what to studies of unified
research. nurses. knowledge.
Graduate What knowledge Carving out Nurses have an Focus graduate
Education Era: is needed for the an important role education on
1950-1970s practice of advanced in health care. knowledge.
nursing? role and
basis for
nursing
practice.
 Historical eras of nursing’s searcH for specialized
knowledge

HISTORICAL MAJOR EMPHASIS OUTCOMES EMERGING

ERA QUESTION GOAL
Theory Era: How do these There are Nursing Theories
1980-1990s frameworks many ways to theoretical guide nursing
guide think about works shift research and
research and nursing. the focus to practice.
practice? the patient.
Theory What new Nursing theory Middle-range Nursing
Utilization Era: theories are guides theory may be frameworks
21st century needed to research, from produce
produce practice, quantitative or knowledge
evidence foe education and qualitative (evidence) for
quality care? administration. approaches quality care.
Significance
of nursing
theory
 Significance of nursing
theory
 DISCIPLINE- specific to academia and refers to
a branch of education, a department of
learning, or domain of knowledge
 PROFESSION- refers to a specialized field of
practice, founded upon the theoretical
structure of the science or knowledge of the
discipline and accompanying practice abilities.
 Significance for the
discipline
 The goal of developing knowledge as a basis for
nursing began to be realized.
 University baccalaureate programs proliferated,
master’s programs in nursing were developed
and a national standardized curriculum was
realized through the accreditation process.
 Nursing research became essential content in
master’s curricula and interest in nursing doctoral
programs was on the increase.
 Significance for the
discipline
 Nursing research became essential content in
master’s curricula and interest in nursing doctoral
programs was on the increase.
 Batey (1977)- called attention to the importance
of nursing conceptualization in the research
process and the role of a conceptual framework
in the design of research for the production of
science.
 This emphasis led into theory development era
that moved nursing toward the goal developing
nursing knowledge to guide nursing practice.
 Significance for the
discipline
 Fawcett (1978) presented her double helix
metaphor on the interdependent relationship
of theory and research.
 Henderson, Nightingale, Orlando, Peplau and
Wiedenbach were recognized for the relevant
nature of their earlier theoretical writings-
developed by educators as frameworks to
structure curriculum content or guide course
content in nursing programs.
 Significance for the
discipline
 Orlando’s (1961, 1972) theory- derived from the
report of an early nationally funded research
project designed to study nursing practice.
 Donaldson and Crowley (1978)
- Reopened the discussion of the nature of nursing
science and the nature of knowledge needed for
the discipline and the profession.
- It become a classic reference for use by students
in considering nursing as a discipline and
recognizing the difference between discipline and
profession.
 Significance for the
discipline
 Donaldson and Crowley (1978)
- Stated that the discipline and the profession are
inextricably linked and failure to recognize and
separate them from each other anchors nursing
in a vocational rather than a professional view.
 Nursing conceptual frameworks began to be used
to organize curricula in nursing programs and
were recognized as models that address the
values and concepts of nursing.
 Significance for the
discipline
 The significance of theory for the discipline of
nursing- the discipline is dependent on theory
for its continued existence.
Nursing can be vocational or nursing can be
discipline with a professional style of theory-based
practice.
 Nurses moved from the functional focus, with
an emphasis on what nurses do, to patient
focus, emphasizing what nurse know for
thought, decision making and action.
 Significance for the
discipline
 Forms of basis in recognizing nursing as
discipline:
a. Knowledge of person
b. Health
c. Environment
 Every discipline or field of knowledge includes
theoretical knowledge.
 Nursing as academic discipline depends on the
existence of nursing knowledge.
 Significance for the
profession
 Theory is essential for the existence of nursing
as an academic discipline.
 Theory is also vital to the practice of
professional nursing.
 Higher degree nursing is recognized as a
profession today.
 Nursing was the subject of numerous studies
by sociologist who used the criteria for a
profession.
 Significance for the
profession
 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 use of the scientific method.
3. Entrust the education of its practitioners to
institutions of higher education.
 Significance for the profession
 Criteria for development of the professional status of
nursing:
4. Applies its body of knowledge in practical services
vital to human and social welfare.
5. Functions autonomously in the formulation 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.
 Significance for the
profession
 Styles (1982)
- Described a distinction between a collective
nursing profession and the individual professional
nurse and called for internal developments for a
new endowment based on ideas and beliefs of
nursing
- The profession needed a new, positive approach
for the future that was devoid of past problems, if
progress in professional development was to
continue.
 Significance for the
profession
 Nursing is recognized as a profession and
emphasis is placed on the relationship between
nursing theoretical works and achievement of
status as a profession.
 The use of substantive knowledge for the theory-
based evidence for nursing is a quality that is
characteristic of their practice.
 The commitment to the theory-based evidence
for practice is beneficial to patients in that it
guides systematic, knowledgeable care.
 Significance for the
profession
 Nursing theory is a tool to be used for:
1. Reasoning
2. Critical thinking
3. Decision-making required for quality nursing
practice
Thank You