History of Nursing

Evolution
review
HISTORICAL EVOLUTION OF NURSING
Period of Intuitive Nursing/ Medieval Period.

Period of Apprentice Nursing/ Middle Ages.

Period of Educated Nursing/ Nightingale Era 19th-20th century

Period of Contemporary Nursing/20th Century

1. Period of Intuitive Nursing/ Medieval Period.
• “Untaught” and instinctive
• Viewed as a natural nurturing job for women
• Expected to take good care of the children, sick and
the aged.
• No caregiving training.
• Based on experience and observation
Trephining – drilling a hole in the skull with a rock or
stone without anaesthesia was a last resort to drive evil
spirits from the body of the afflicted.
2. Period of Apprentice/
Nursing Middle Ages
Care was done by:

Crusaders,
Prisoners,
Religious orders
• This kind of nursing was developed by religious orders
of the Christian Church.

• Nursing went down to the lowest level

• Wrath/anger of Protestantism removed properties of

hospitalsand schools connected with Roman
Catholicism.
Nursing became the work of the least desirable of
women – Prostitutes, Alcoholics, Prisoners

Pastor Theodore Fliedner and his wife, Fredericka

established the Kaiserswerth Institute for the training
of Deaconesses (the 1st formal training school for
nurses) in Germany.
3. Period of Educated Nursing / Nightingale Era
19th-20th century
The development of nursing during this period was strongly
influenced by:

• Trends resulting from wars – Crimean, Civil war

• Arousal of social consciousness

• Increased educational opportunities offered to women

In 1860, The Nightingale Training School of Nurses
opened at St. Thomas Hospital in London.

The school served as a model for other training schools.

Its graduates traveled to other countries to manage

hospitals and institute nurse-training programs.
4. Period of Contemporary Nursing / 20th
Century
• Licensure of nurses started

• Specialization of Hospital and diagnosis

• Training of Nurses in diploma program

Historical eras in nursing

• Curriculum era

• Research era

• Graduate nursing era

• Theory era
Curriculum era

Addressed the question of what prospective nurses must

study and learn to become a nurse. i.e. Courses nurses need to
take, the need to move from hospital based nursing program
to college level education and university level education.
Research era
As more and more nurses sought degrees in higher
education, research era emerged. Nurses began to
participate in research and research course began to be
included in nursing curricula.
Graduate nursing education era
Masters program in nursing emerged to meet the need for
nurse with specialized education in nursing

The masters education had an embedded course in nursing

research nearing the end of this era a course in nursing theory
or nursing conceptual models that introduced students to the
early nursing theorists and development of nursing theories
was introduced.
Theory era
Was the natural outgrowth of research era.

With an increased understanding of research and knowledge

development

It became obvious that research without theory produced

isolated information, however research and theory produced
nursing science.
answer : c -graduate education era
Master’s degree programs in nursing emerged in which of the following
era?

a. Curriculum era
b. Theory Utilization
c. Graduate education era
answer: b- Curriculum era
This era emphasis on what course a nursing student should take to be a
professional nurse.

a. Research era
b. Curriculum era
c. Theory Utilization
answer: - b. Kaisserwerth Institute
Which of the ff. is the first formal training school for nurses?

a. St. Thomas School

b. Kaisserwerth Institute
c. Helsinki Swedish School of Nursing
answer: a. 20th century era
when was licensure examination for nursing was establish to ensure
competence among nursing graduates?

a. 20th century era

b. curriculum era
c. graduate study era
answer: b.middle ages
It is when nursing went to its lowest form and became the work of the
least desirable women.

a. medieval period
b.middle ages
c.contemporary nursing period
answer: c. Florence Nightingale
Which of the following nursing advocates elevated the status of nursing
to a respected occupation, improved the quality of nursing care, and
founded modern nursing education?

a. Clara Barton
b. Dorothea Dix
c. Florence Nightingale
answer: a. Theory utilization
This era refers to which new theories are needed to produce evidence
for quality of care?

a. Theory utilization
b. Curriculum era
c. Graduate education era
answer: b. Discipline
Which of the following refers to specific academia and a branch of
education, a department of learning or field of knowledge?

a. Occupation
b. Discipline
c. Profession
answer: c. Profession
Which of the following refers to a specialized field of practice, founded
on the theoretical structure of the science or knowledge of that
discipline and the accompanying practice abilities?

a. Occupation
b. Discipline
c. Profession
Structural level of Nursing
Knowledge
levels of Nursing theory
Metaparadigm theory
The fourth level of theory or Meta theory is the highest
level of theory, and is defined by the prefix META,
meaning “changed in position”, “beyond”, “on a higher
level”, or “transcending,”

Meta theory is criticized as being limited,

without boundaries, abstract and very difficult
for practical application.
Grand Theory
• The third level of nursing theory is Grand Theory

• Emphasizes a global viewpoint with a board perspective of nursing

practice, and a distinct nursing perspective of nursing phenomenon.

• Fawcett (1995) defined Grand Theories as the broadest in scope, less

abstract than conceptual models but composed of general concepts
still relatively abstract, and the relationships cannot be tested
empirically.
Middle range theories
• Middle Range Theories, the second level of nursing theories which is
least abstract, are moderately abstract, inclusive, organized within a
limited scope; have a limited number of variables (age, location, or
practices), which are testable in a direct manner.

• The mid-range theories have a stronger relationship with research

and practice.
Practice theories/Microtheory
• Practice nursing theories are situation-specific theories that
are narrow in scope and focuses on a specific patient
population at a specific time.
• Practice-level nursing theories provide frameworks for
nursing interventions and suggest outcomes or the effect of
nursing practice
answer:
Patient X was unconscious and in a state of coma. The patient has been
lying on bed for several days. In order to avoid developing a bedsore or
pressure ulcer, Nurse Alma routinely turned her patient side to side
every two hours. The action of the nurse BEST describes what type of
theory?

a. Practice Theory
b. Needs Theory
c. Descriptive Theory
Answer:
They are least abstract level of theoretical knowledge because they
include details specific to nursing practice. This thoery covers variables
such as population or age group, the location or area of practice and
the action of the nurse or the intervention.

a. Middle Range theory

b. Meta Theory
c. Grand Theory
answer:
Are defined as the broadest in scope, less abstract than conceptual
models but composed of general concepts still relatively abstract.

a. Meta Theory
b. Grand Theory
c. Practice Theory
Categories based on philosophical
underpinnings:

"Needs "theories.
"Interaction" theories.
"Outcome "theories.
"Humanistic theories"
Humanistic theories
• Humanistic theories emphasize a person’s capacity for self
actualization. The humanistic theory approach engages social skills,
feelings, intellect, artistic skills, practical skills, and more as part of
their education.

• Nurse’s training should focus as much on the nurse’s ability to relate

to and interact with patients as a scientific and medical background.
Needs theories

These theories are based around helping individuals to fulfill

their physical and mental needs.

Needs theories have been criticized for relying too much on

the medical model of health and placing the patient in an
overtly dependent position.
Outcome theories

These portray the nurse as the changing force, who enables

individuals to adapt to or cope with ill health (Roy 1980).

e.g. Nurse Ben helped the patient change the alcoholism of

the patient through rehabilitative nursing practices.
Interaction theories
These theories emphasized
nursing on the establishment and
maintenance of relationships.
They highlighted the impact of
nursing on patients and how they
interact with the environment,
people, and situations.
answer:
This theory is developed in order for a person to reach the capacity for
self-actualization and the potential of an individual for healthy and
creative growth.

a. Interaction Theory
b. Humanistic Theory
c. Needs Theory
answer:
Nurse B is giving tepid sponge bath, providing good ventilation, and
warming the room for a patient who has hyperthermia (fever). Based
on the circumstance that has been provided what type of theory under
philosophical underpinnings was described?

a. Interaction Theory
b. Humanistic Theory
c. Needs Theory
answer:
These portray the nurse as the changing force, who enables
individuals to adapt to or cope with ill health.

a. Interaction Theories
b. Needs Theories
c. Outcome Theories
Categories based on functions:

• Descriptive
• Explanatory
• Predictive
• Prescriptive
Descriptive theories

Descriptive theories describe, observe, and name

concepts, properties, and dimensions, but they do not
indicate how changes in one concept affect other
concepts.
Explanatory theories

Relate concepts to one another and describe and specify some

of the association or interrelations between and among the
concepts.

Further, explanatory theories attempt to tell how or why the

concepts are related and may deal with causes, correlations,
and rules that regulate interactions (Barnum,. 1998; Dickoff et
al., 1968).
Predictive theories
• Predictive theories presuppose the prior existence of the
more elementary types of theory.
• They result after concepts are defined and relational
statements are generated and are able to describe
future outcomes consistently.
• Predictive theories include statements of causal or
consequential relatedness (Dickoff et al., 1968).
Prescriptive theories

• are perceived to be the highest level of theory development

(Dickoff et al., 1968)
• Prescriptive theories prescribe activities necessary to reach
defined goals.
• In nursing, prescriptive theories address nursing therapeutics
and predict the consequence of interventions (Meleis, 2005).
answer: a. Growth and Development
Which of the following is an example of a Descriptive theory?

a. Growth and Development

b. Stress
c. Pain
Categories Based on Processes in the
Development Of Nursing Theories
General System Theory:

It describes how to break whole things into parts and then to

learn how the parts work together in " systems". These
concepts may be applied to different kinds of systems,

e.g.Betty Newman’s systems theory.

Developmental Theory

• It outlines the process of growth and development of humans as orderly

and predictable , beginning with conception and ending with death.

• The progress and behaviors of an individual within each stage are unique.

• The growth and development of an individual are influenced by heredity ,

temperament , emotional, and physical environment , life experiences and
health status.
Adaptation Theory
It defines adaptation as the adjustment of living matter to other living things and to
environmental conditions. Adaptation is a continuously occurring process that
effects
change and involves interaction and response. Human adaptation occurs on three
levels:

--- the internal ( self )

--- the social (others)

--- and the physical ( biochemical reactions )

It describes how to break whole things into parts and then to learn how
the parts work together in " systems". These concepts may be applied
to different kinds of systems.

a. General Systems Theory

b. Adaptation Theory
c. Grand Theory
answer:
It defines adaptation as the adjustment of living matter to other living
things and to environmental conditions. Adaptation is a continuously
occurring process that effects change and involves interaction and
response.

a. Developmental Theory
b. Grand Theory
c. Adaptation Theory
answer:
It is the creation of a conceptual meaning, that includes, specifying,
defining, and clarifying the concepts used to describe the phenomenon
of interest.

a. Concept Derivation
b. Concept Development
c. Concept Synthesis
answer:
Commonly used to describe an encapsulation of theories,
methodologies, beliefs & concepts that are combined into the makeup
of a worldview or a perspective on life & how it works.

a. Nursing Paradigm
b. Nursing Management
c. Nursing Conceptual Models
answer: c. Nursing Conceptual Models
Concepts can be thought as the individual bricks and boards used to
build a house; with the Conceptual Framework being the blueprint that
specifies where each brick or board should go.
{
a. Nursing Paradigm
b. Nursing Process
c. Nursing Conceptual Models
answer:
These are the building blocks of theories and used to represent the
phenomenon observed or experienced.

a. concepts
b. assumptions
c. hypotheses
It refers to the recipient of nursing care, including physical, spiritual,
psychological, and sociocultural components, and can include an
individual, family, or community.

a. Nursing
b. Person
c. Environment
What stage in theory development where theories were borr
owed from other medical disciplines?

a. subjective knowledge stage

b. received knowledge stage
c. procedural knowledge stage
answer: c. 1950
Which of the following year declared nursing as a science?

a. 1970
b. 1912
c. 1950
answer:
Which of the following is true about empiricism?

a. Emphasizes the importance of prior reasoning

b. Utilizes inductive reasoning
c. Feelings
answer: b. Emergent Views of Science
Empericist argue that for Science to maintain it’s objectivity, analysis,
and collection of data must be independent from theory. This refers
to…

a.Emergent interpretation
b. Emergent Views of Science
c. Rationalism
thank you for listening
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