Introduction to Nursing Theory:

Its History, and Significance

Prepared by:
JOAN BALITON- TAROMA, MSN,RN
 Learning Objectives:
After the discussion, the students will be able to:
• 1. Discuss the different Era of History of
Nursing Theory.
• 2. Discuss Significance of Nursing Theory.
• 3. Discuss Significance of the Profession

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• The history of professional nursing began with
Florence Nightingale.
• It was Nightingale who envisioned nurses as a
body of educated women at a time when
women were neither educated nor employed
in public service.

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• Nightingale’s pioneering activities in nursing
practice and subsequent writings describing
nursing education became a guide for
establishing nursing schools in the United
States at the beginning of the twentieth
century (Kalisch & Kalisch, 2003; Nightingale,
1859/1969)

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• 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.

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• Nursing began with a strong emphasis on
practice, but throughout the century, nurses
worked toward the development of nursing as
a profession through successive periods
recognized as historical eras (Alligood, 2006a).

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 curriculum era
• addressed the question of what prospective
nurses should study to learn how to be a
nurse.
• In this era, the emphasis was on what courses
nursing students should take, with the goal of
arriving at a standardized curriculum
(Alligood, 2006a).

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By the mid-1930s, a standardized curriculum
had been published. However, it was also in
this era that the idea of moving nursing
education from hospital-based diploma
programs into colleges and universities
emerged. Even so, it was the middle of the
century before this goal began to be acted
upon in many states (Kalisch & Kalisch, 2003).
Emphasized course selection and content for
nursing programs and gave to the long- range
goal of acquiring substantive knowledge to
guide nursing practice.
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research emphasis era
• This era came about as more and more nurses
embraced higher education and arrived at a
common understanding of the scientific age,
that is, that research is the path to new
nursing knowledge.
• Nurses began to participate in research, and
research courses began to be included in the
nursing curricula of many developing graduate
programs (Alligood, 2006a).
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 The research era and the graduate
education era
• Master’s degree programs in nursing emerged
to meet the public need for nurses with
specialized clinical nursing education. Many of
these programs included a nursing research
course. It was also in this era that most nursing
master’s programs began to include courses in
concept development or nursing models that
introduced students to early nursing theorists
and the knowledge development process
(Alligood, 2006a).
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 theory era
• was a natural outgrowth of the research and
graduate education eras. As our understanding of
research and knowledge development increased, it
soon became obvious that research without theory
produced isolated information, and that it was
research and theory together that produced nursing
science (Batey, 1977; Fawcett, 1978; Hardy, 1978).
• In the early years of the theory era, doctoral
education in nursing flourished with an emphasis on
theory development.

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• A period of major development in nursing
theory that has been characterized as a
transition from the paradigm to the paradigm
period in nursing (Fawcett, 1984; Hardy,
1978;Kuhn, 1970).
• The prevailing nursing paradigms (models)
provided perspectives for education, nursing
practice, research, administration, and further
theory development.
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• Classifying the nursing models as paradigms
within metaparadigm concepts of Person,
Nursing, environment and Health
systematically united nursing theoretical
works for the discipline.
• This system clarified and improved
comprehension of knowledge development by
positioning the theorist’s works in a larger
context, thus greatly facilitating the growth of
nursing science.

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 In the theory utilization era
emphasis was placed on middle range theory
for theory-based nursing practice, as well as
on theory development (Alligood & Tomey,
1997, 2002, 2006; Batey, 1977; Chinn &
Kramer, 2008; Fawcett, 2005; Tomey &
Alligood, 2006).

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• The development and use of theory era led to
what is recognized today as the nursing theory
led to what is recognized as the nursing theory
era. (Alligood, 2014; Nicoll,1986, 1992, 1997;
Reed & Shearer, 2012: Reed, Shearer,& Nicoll,
2003;Wood, 2014). It was as Fitpatrick and
Whall(1983) had said, “nursing is on the brink
of anexciting new era”.

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 HISTORICAL ERAS OF NURSING’S SEARCH FOR
SPECIALIZED KNOWLEDGE
HISTORICAL ERA MAJOR EMPHASIS OUTCOMES EMERGING GOAL
QUESTION
CURRICULUM ERA What Courses Standardized Develop
curriculum included in curricula doe specialized
content should nursing diploma knowledge and
student nurses programs programs higher education
study to be
nurses
RESEARCH ERA What is the Role of nurses Problem studies Isolated studies
focus for and what to and studies of not yield unified
nursing research nurses knowledge.
research?
GRADUATE What Carving out an Nurses have an Focus graduate
EDUCATION ERA knowledge is advanced role important role education on
needed for the and basis for in health care. knowledge
practice of nursing development.
nursing? Nursing Theories
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THEORY ERA How do There are Nursing Theories guide
theses many ways to theoretical nursing
frameworks think about works shift the research and
guide nursing. focus to the practice.
research and patient.
practice?

THEORY What new Nursing theory Middle-range Nursing

UTILIZATION ERA: theories are guides theory may be frameworks
21st century needed to research, from produce
produced practice, quantitative knowledge(
evidence for education, and approaches. evidence) for
quality care? administration quality care.

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 SIGNIFICANCE OF NURSING
THEORY:
• DISCIPLINE: is a specific to academia and
refers to a branch of education, a department
of learning, or a domain of knowledge.
• PROFESSION: refers to a specialized field of
practice, founded on the theoretical structure
of the science or knowledge of that discipline
and accompanying practice abilities.

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• Nurses use theory and theory-based evidence
to structure their practice and quality of care
improves.
• They are able to not only sort patient data
quickly, decide on appropriate nursing action,
deliver care, and evaluate outcomes but also
discuss the nature of their practice clearly
with other health professionals, which is vital
for nurse participation in interdisciplinary
care.

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• Helps students develop analytical skills and
critical thinking ability as they clarify their
values and assumptions.
• Theory guides education, practice, research,
and administration (Alligood, 2014;Chinn&
Kramer, 2015; Fawcett & De Santo-Madeya,
2012; Meleis,2012)

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 SIGNIFICANCE OF DISCIPLINE
• The goal of developing knowledge as a basis
for nursing practice began to be realized.
• University baccalaureate programs
proliferated , master’s programs in nursing
were developed, and a standardized
curriculum was realized through accreditation.

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• Nursing had passed through eras of gradual
development, and nursing leaders offered
their perspectives on the development of
nursing leaders offered their perspectives on
the development of nursing science.
• 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.
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 SIGNIFICANCE FOR THE
PROFESSION
• Vital to the practice of professional nursing (
McCrae, 2012)
• Recognition as a profession seemed to be less
urgent issue as the 20th century ended bec. Of
consistent progress in the nursing theory era
to solidify professional status.
• Nursing is recognized as a profession today
bec. Its developed was guided by the criteria
for a profession.
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 CRITERIA FOR THE 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
the 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.

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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 formulation of
professional policy and thereby in the control of
professional activity.

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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.

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 HISTORY OF NURSING SCIENCE
HISTORICAL VIEWS OF THE NATURE OF
SCIENCE
2 PHILOSOPHICAL PERSPECTIVE:
1. Rationalism
2. Empiricism
• Each is a type of epistemology that is a theory
of knowledge for understanding how to
uncover the answer to a question.
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 RATIONALISM
• Rationalist epistemology (scope of knowledge)
emphasizes the importance of a priori
reasoning as the appropriate method for
advancing knowledge.
• A prio reasoning uses deductive logic by
reasoning from the cause to an effort or from
a generalization to a particular instance.

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 EMPIRICISM
The empirist view is based on the central idea
that scientific knowledge can be derived only
from sensory experience.
Inductive method
- Based on the idea that the collection of facts
precedes attempts to formulate generalizations,
or as Reynolds (1971) called it, the research-
then-theory strategy.
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 Early 20th century
• Scientist focused on empirical research
(Brown, 1977).
• There was minimal interest in the history of
science, the nature of scientific discovery, or
the similarities between the philosophical
view of science and the scientific
methods(Brown, 1977).

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• Positivism, a term first used by Comte,
emerged as the dominant view of modern
science( Gale, 1979).
• The increasing of use of computers which
permit the analysis of large data sets, may
have contributed to the acceptance of the
positivist approach to modern science(
Snelbecker, 1974)
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EMERGENT VIEWS OF SCIENCE AND THEORY IN
THE LATE 20TH CENTURY
17th- 19th century- Foucault(1973) published
his analysis of the epistemology(knowledge)
of human sciences.
- His major thesis stated that empirical
knowledge was arranged in different patterns at
a given time and in given culture and that
humans were emerging as objects of the study.

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• In the new epistemology, science is viewed as
an ongoing process. Much importance is given
to the idea of consensus among scientists.
• Brown (1977) concluded, it is a myth that
science can establish final truths.
• In this view, scientific knowledge is what the
consensus of scientist in any given historical
era regard as scientific knowledge(Brown,
1977)
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• It is through this evidence that we begin to
understand evidence-based science.
• Nursing uses evidence- based science to
support the interventions performed in the
care of patients.

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