MODULE 1

EVOLUTION OF NURSING
 EVOLUTION OF NURSING

 Module Outcomes:
At the end of the module, the student should be able to:
 Define a nursing theory and its significance to the philosophy of science.
 Discuss the development of nursing theory as structure of nursing knowledge.

 Module Content:
 Introduction to Nursing Theory
 History and Philosophy of Science
 Structure of Nursing Knowledge
Definition of Terms

 Assumptions are beliefs about phenomena perceived as true to accept a theory and may not be
susceptible to testing.
 Concepts are the elements or components of a phenomenon necessary to understand the
phenomenon. They are abstract and derived from impressions the human mind receives about
phenomena through sensing the environment.
 A conceptual model is a set of interrelated concepts that symbolically represents and conveys a
mental image of a phenomenon.
 Hypotheses are tentative suggestions that a specific relationship exists between two concepts or
propositions. As the hypothesis is repeatedly confirmed, it progresses to an empirical
generalization and ultimately to a law.
 Knowledge refers to the awareness or perception of reality acquired through insight, learning, or
investigation. In a discipline, knowledge is what is collectively seen to be a reasonably accurate
understanding of the world as seen by members of the discipline.
 Law is a proposition about the relationship between concepts in a theory that has been
repeatedly validated. Laws are highly generalizable. Laws are found primarily in disciplines that
deal with observable and measurable phenomena, such as chemistry and physics. Conversely,
social and human sciences have few laws.
 Metaparadigm represents the worldview of a discipline—the global perspective that subsumes more
specific views and approaches to the central concepts with which the discipline is concerned. The
metaparadigm is the ideology within which the theories, knowledge, and processes for knowing find
meaning and coherence.
 Models are graphic or symbolic representations of phenomena that objectify and present certain
perspectives or points of view about nature or function or both. Models may be theoretical (something not
directly observable—expressed in language or mathematics symbols) or empirical (replicas of observable
reality—model of an eye, for example).
 Paradigm is an organizing framework that contains concepts, theories, assumptions, beliefs, values, and
principles that form the way a discipline interprets the subject matter with which it is concerned. It
describes work to be done and frames an orientation within which the work will be accomplished. A
discipline may have a number of paradigms.
 Propositions are statements of a constant relationship between two or more concepts or facts; suggestion;
opinion
 Philosophy is a statement of beliefs and values about human beings and their world.
 Theory refers to a set of logically interrelated concepts, statements, propositions, and definitions, which
have been derived from philosophical beliefs of scientific data and from which questions or hypotheses can
be deduced, tested, and verified. A theory purports to account for or characterize some phenomenon.
Theory

Characteristics of Theory
 Logical, simple and generalizable
 Composed of concepts and propositions
 Provide the bases for testable hypotheses
 Consistent with other validated theories
 Contribute to body of knowledge
Classification of Theories Based on Purpose
 factor-isolating theories (descriptive theories)
Components of Theory  factor-relating theories (explanatory theories)
 purpose  situation-relating theories (predictive theories)
 concepts and definitions  situation-producing theories (prescriptive theories)
 theoretical statements
 structure/linkages and ordering
 assumptions
 Lesson 1: Introduction to Nursing Theory
 A. History of Nursing Theory

 Half of 20th century-Nursing as a discipline

 “The systematic accumulation
 Theory to guide nursing practice is essential
 21ST CENTURY:
 Theory- patient focus and framework to
sort patient data
 Guides thinking and nursing action
 Theory informs practice and vice versa
of knowledge is essential to
progress in any profession…
however theory and practice
must be constantly interactive.
Theory without practice is
empty and practice without
theory is blind” (Cross, 1981,
p. 110).

FLORENCE NIGHTINGALE
 Highlights of Significant Events in Nursing History

1. Florence Nightingale
1859/1992 (Notes on Nursing)- 1st nursing theory that focuses on manipulation of the environment for patient’s
benefit
2. The Columbia School
1950s- graduate level for administrative and faculty positions for nurses
 Graduates: Peplau, Henderson, Hall, Abdellah
 Focus: functional roles of nurses, patient’s needs and problems
 Medical diagnosis is different from nursing diagnosis
3. Yale School
1960s- Focus: Nurse-patient relationship
 Graduates: Orlando and Wiedenbach
 Nursing as a process rather than an end in itself
 Federal funds for doctoral study for nurse educators were made available
4. 1970s, 1980s, 1990s
- Development of several nursing theories
 Eras of Nursing Knowledge

1. Curriculum Era
2. Research Era
3. Graduate Education Era
4. Theory Era
5. Theory Utilization Era

1. Curriculum Era (1900-1940s)

 Emphasis: curriculum content; Goal: standardized curricula, to develop specialized knowledge and
higher education
 Expansion of curricula beyond physiological and pathophysiological knowledge to social sciences,
pharmacology and nursing procedures
 “art of nursing” was changed to “science of nursing”
 Emergence of “nursing arts laboratory” (nursing procedures in ward); skills lab (science and research)
2. Research Era (1950-1970s)
 Research became the driving force. Nurses were encouraged to learn how to conduct
research, developing the role for nurses for that specialized body of knowledge.
 Research is the basis of nursing practice.
 Emphasis: scholarship; the need to disseminate research findings in scholarly
publications

3. Graduation Era (1950-1970s)

 Curricula for master’s- level preparation included nursing research, clinical specialty practice and leadership.
 Nurses advance to doctorate programs
 Focus: nursing science and theory development
 BATEY (1977) :conceptualization is the greatest limitation of nursing research; theory is a set of related
concepts
 Start of publication of several nursing frameworks (Johnson, King, Levine, etc)
4. Theory Era (1980-1990s)
 Emphasis: nursing theory development (cornerstone of nursing)
 Focus: proliferation of nursing literature and new nursing journals, national and
international nursing conferences, and opening of new nursing doctoral program

5. Theory Utilization Era (21st century)

 Emphasis: utilization of philosophies, models or theories in practice (theory based
nursing practice)
 Focus: from theory development to theory application and utilization using critical
thinking
 B. Significance of Nursing Theory

 Discipline vs Profession
 Discipline- academe specific; branch of education, department of learning or domain of
knowledge
 Profession- practice specific; specialized field founded on the theoretical structure of the science
or knowledge of the discipline and accompanying practice abilities

Significance of Nursing Theory to Discipline

 Nursing discipline is dependent on theory and knowledge for its continued existence
 These theoretical works have taken nursing to higher levels of education and practice as nurses shift from
functional focus to patient focus
 Students of Master’s Degree, DNP or Doctors of Nursing Practice, PhD continue to test and develop nursing
theories, thereby generating research studies

Significance of Nursing Theory to Profession

 The commitment to theory-based evidence for practice is beneficial to patients in that it guides a systematic
and knowledgeable care.
 This serves as a tool for reasoning, critical thinking and decision making in quality nursing practice.