EVOLUTION OF NURSING

Prepared by:
Carole D. Garcia, RN, LPT, MAN
INTRODUCTION TO NURSING THEORY

HISTORY OF NURSING THEORY

 Florence Nightingale
• 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.
• Following her service of organizing and caring for the
wounded in Scutari, during the Crimean War, her vision
and establishment of a School of Nursing at St. Thomas’
Hospital in London marked the birth of modern nursing.
INTRODUCTION TO NURSING THEORY

• “academic discipline” with a specialized body

of knowledge
• nurse’s proper function as putting the patient in the
best condition for nature (God) to act upon him or
her.
• care of the sick is based on knowledge of
persons and their surroundings
INTRODUCTION TO NURSING THEORY

• 1950s - “nursing as a science” based on principles

and traditions that were handed down through an
apprenticeship model of education
• transition from vocation to profession
• 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
INTRODUCTION TO NURSING THEORY

• 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
INTRODUCTION TO NURSING THEORY
• Curriculum Era
• The 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).
• 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
INTRODUCTION TO NURSING THEORY
 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
1. standardization of curricula for nursing master’s
education by the National League for Nursing
accreditation criteria for baccalaureate and higher-
degree programs
2. doctoral education for nurses should be in nursing
INTRODUCTION TO NURSING THEORY
 Graduate Education Era
 The research era and the graduate education era
developed in tandem. 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
• graduate programs included a course that introduced the
student to the research process.
INTRODUCTION TO NURSING THEORY
• Theory Era
• The 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.
• In the early years of the theory era, doctoral education in
nursing flourished with an emphasis on theory
development.
• strong emphasis on theory development and testing
• 1978 - theorists were recognized as nursing theorists and
their works as nursing conceptual models and theories
(Nurse Educator Conference, New York City)
INTRODUCTION TO NURSING THEORY

 1980’s
• Transition from the pre-paradigm to the paradigm
period
• metaparadigm of the person, environment, health,
and nursing
INTRODUCTION TO NURSING THEORY

 Theory Utilization Era

• theory application in nursing practice, education,
administration, and research
• emphasis was placed on middle range theory for
theory-based nursing practice, as well as on theory
development
• continues today, emphasizing the development and
use of nursing theory and producing evidence for
professional practice.
INTRODUCTION TO NURSING THEORY
SIGNIFICANCE OF NURSING THEORY

 Significance for the Discipline

• Discipline - is specific to academia and refers to a
branch of education, a department of learning, or a
domain of knowledge.
• Discipline is dependent upon theory for its continued
existence, that is, we can be a vocation, or we can be
a discipline with a professional style of theory-based
practice.
SIGNIFICANCE OF NURSING THEORY

 Significance for the Profession

• Profession - refers to a specialized field of practice,
founded upon the theoretical structure of the
science or knowledge of that discipline and
accompanying practice abilities.
• Theory enables them to organize and understand
what happens in practice
SIGNIFICANCE OF NURSING THEORY

 Significance for the Profession

• To analyze patient situations critically for clinical
decision making;
• To plan care and propose appropriate nursing
interventions;
• And to predict patient outcomes from the care and
evaluate its effectiveness.
ANALYSIS OF THEORY

• Clarity: How clear is this theory?

• Simplicity: How simple is this theory?
• Generality: How general is this theory?
• Accessibility: How accessible is this theory?
• Importance: How important is this theory?
HISTORY AND PHILOSOPHY OF SCIENCE

 Rationalism
• Rationalist epistemology (scope of knowledge)
emphasizes the importance of a priori reasoning as
the appropriate method for advancing knowledge. A
priori reasoning utilizes deductive logic by reasoning
from the cause to an effect or from a generalization
to a particular instance.
• Theory-then-research approach (deductive)
• Example: to reason that a lack of social support
(cause) will result in hospital readmission (effect).
HISTORY AND PHILOSOPHY OF SCIENCE
 Empiricism
• The empiricist view is based on the central idea that
scientific knowledge can be derived only from
sensory experience (i.e., seeing, feeling, hearing
facts).
• Generalizing observed facts in the natural world.
(Francis Bacon)
• Research-then-theory approach (inductive)
• Example: Formulating a differential diagnosis
requires collecting the facts and then devising a list
of possible theories to explain the facts.
EARLY TWENTIETH CENTURY VIEWS
• During the first half of this
century, philosophers focused on the analysis of
theory structure, whereas scientists focused on
empirical research. 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. Positivism, a term
first used by Comte, emerged as the dominant view
of modern science. Modern logical positivists
believed that empirical research and logical analysis
(deductive and inductive) were two approaches that
would produce scientific knowledge
EARLY TWENTIETH CENTURY VIEWS
• The logical empiricists offered a more lenient view of
logical positivism and argued that theoretical
propositions (proposition affirms or denies something)
must be tested through observation and experimentation
This perspective is rooted in the idea that empirical facts
exist independently of theories and offer the only basis
for objectivity in science. In this view, objective truth
exists independently of the researcher, and the task of
science is to discover it, which is an inductive method.
This view of science is often presented in research
method courses as: “The scientist first sets up an
experiment; observes what occurs …. reaches a
preliminary hypothesis to describe the occurrence; runs
further experiments to test the hypothesis [and] finally
corrects or modifies the hypothesis in light of the results”
EARLY TWENTIETH CENTURY VIEWS

• The increasing 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). However, in the 1950s,
the literature began to reflect an increasing challenge
to the positivist view, thereby ushering in a new view
of science in the late twentieth century (Brown,
1977).
EMERGENT VIEWS
 In the latter years of the twentieth century, several authors presented
analyses challenging the positivist position, thus offering the basis for a
new perspective of science (Brown, 1977; Foucault, 1973; Hanson,
1958; Kuhn, 1962; Toulmin, 1961). Foucault (1973) published his analysis
of the epistemology (knowledge) of human sciences from the seventeenth
to the nineteenth century. His major thesis stated that empirical
knowledge was arranged in different patterns at a given time and in a
given culture and that humans where emerging as objects of study. In The
Phenomenology of the Social World, Schutz (1967) argued that scientists
seeking to understand the social world could not cognitively know an
external world that is independent of their own life experiences.
Phenomenology, set forth by Edmund Husserl (1859 to 1938) proposed
that the objectivism of science could not provide an adequate
apprehension of the world (Husserl 1931, 1970). A phenomenological
approach reduces observations or text to the meanings of phenomena
independent of their particular context. This approach focuses on the lived
meaning of experiences.
EMERGENT VIEWS
 In 1977, Brown argued an intellectual revolution in philosophy that
emphasized the history of science was replacing formal logic as the
major analytical tool in the philosophy of science. One of the major
perspectives in the new philosophy emphasized science as a
process of continuing research rather than a product focused on
findings. In this emergent epistemology, emphasis shifted to
understanding scientific discovery and process as theories change
over time.
EMERGENT VIEWS
 Empiricists view phenomena objectively, collect data, and
analyze it to inductively proposed theory (Brown, 1977). This
position is based upon objective truth existing in the world,
waiting to be discovered. Brown (1977) set forth a new
epistemology challenging the empiricist view proposing that
theories play a significant role in determining what the
scientist observes and how it is interpreted. The following
story illustrates Brown’s premise that observations are
concept laden; that is, an observation is influenced by values
and ideas in the mind of the observer:
EMERGENT VIEWS

 Husserl - objectivism of science could not provide an

adequate apprehension of the world
• Brown – science as a process of continuing research
rather than a product focused on findings.
STRUCTURE OF NURSING KNOWLEDGE

• Nursing Paradigm - Patterns or models used to show

a clear relationship among the existing theoretical
works in nursing
 Metaparadigm - Present theories are focused on the
relationship of four major concepts:
• Person
• Environment
• Health
• Nursing
STRUCTURE OF NURSING KNOWLEDGE
1. Person
 The recipient of care: individual, families and
communities
2. Environment
 The external and internal aspects of life that influence the
person
3. Health
 The holistic level of wellness that the person experiences
4. Nursing
 The interventions of the nurse rendering care in support
of, or in cooperation with the client
STRUCTURE OF NURSING KNOWLEDGE

 Philosophy - is the most abstract type and sets forth

the meaning of nursing phenomena through analysis,
reasoning, and logical presentation
 Conceptual models - comprises nursing works by
theorists referred to by some as pioneers in nursing.
It provides a distinct frame of reference for its
adherents that tells them how to observe and
interpret the phenomena of interest to the
discipline
STRUCTURE OF NURSING KNOWLEDGE

 Theory - comprises works derived from nursing

philosophies, conceptual models, abstract nursing
theories, or works in other disciplines
 Middle-range theories - are precise and answer
specific nursing practice questions. They address the
specifics of nursing situations within the perspective
of the model or theory from which they are derived.
Most specific focus and is concrete in its level of
abstraction
STRUCTURE OF NURSING KNOWLEDGE
STRUCTURE OF NURSING KNOWLEDGE
STRUCTURE OF NURSING KNOWLEDGE

REFERENCE:
• Alligood, M. (2014).Nursing Theories and Their Works
(8th ed.). St. Louis, Missouri: Elsevier Mosby.
Thank You!