EVOLUTION OF NURSING THEORIES

Introduction to Nursing Theory:

Its History and Significance

“The systematic accumulation 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

HISTORY OF NURSING THEORY

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

After her wartime service of organizing and caring for the wounded in Scutari during the Crimean War,
Nightingale’s vision and establishment of a School of Nursing at St. Thomas’ Hospital in London marked
the birth of modern nursing.

 Nightingale’s (1859/1969) vision of nursing has been practiced for more than a century, and
theory development in nursing has evolved rapidly over the past 6 decades, leading to the
recognition of nursing as an academic discipline with a specialized body of knowledge.
 The transition from vocation to profession is described here in successive eras of history as
nurses began developing a body of specialized knowledge on which to base nursing practice.
 Nurses began with a strong em phasis on practice, and worked throughout the century toward
the development of nursing as a profession.

Nightingale’s (1859/1969) vision of nursing has been practiced for more than a century, and theory
development in nursing has evolved rapidly over the past 6 decades, leading to the recognition of
nursing as an academic discipline with a specialized body of knowledge.

She described a nurse’s proper function as putting the patient in the best condition for nature (God) to
act upon him or her. She set forth the following: that care of the sick is based on knowledge of persons
and their surroundings—a different knowledge base than that used by physicians in their practice

The transition from vocation to profession is described here in successive eras of history as nurses began
developing a body of specialized knowledge on which to base nursing practice. Nurses began with a
strong emphasis on practice, and worked throughout the century toward the development of nursing as
a profession. Progress in each of these eras toward the goal of a specialized basis for nursing practice
demonstrates the seriousness of this drive toward professional development.
The curriculum era addressed the question of what content nurses should study to learn how to be a
nurse. During this era, the emphasis was on what courses nursing students should take, with the goal of
arriving at a standardized curriculum.

As nurses increasingly sought degrees in higher education, the research emphasis era began to emerge.
During the midcentury more nurse leaders embraced higher education and arrived at an understanding
of the scientific age and that research was the path to new nursing knowledge. Nurses began to
participate in research, and research courses were included in nursing curricula in early graduate nursing
programs (Alligood, 2014

The research era and the graduate education era developed in tandem. Master’s degree programs in
nursing emerged across the country to meet the public need for nurses for specialized clinical nursing
practice. Many of these graduate programs included a course that introduced the student to the
research process. Also during this era, nursing master’s programs began to include courses in concept
development and nursing models, introducing students to early nursing theorists and knowledge
development processes (Alligood, 2014). The development of nursing knowledge was a major force at
this time.

Nurse researchers worked to develop and clarify a specialized body of nursing knowledge, with
the goals of improving the quality of patient care, providing a professional style of practice, and
achieving recognition as a profession.

The theory era was a natural outgrowth of the research and graduate education eras

As understanding of research and knowledge development increased, it became obvious that research
without conceptual and theoretical frameworks produced isolated information rather than a body of
nursing knowledge

. The theory era accelerated as early works developed as frameworks for curricula and advanced practice
guides began to be recognized as theory.

The 1980s was a period of major developments in nursing theory that has been characterized as
a transition from the preparadigm 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.

These observations of nursing theory development progress bring Kuhn’s (1970) description of
normal science to life. His philosophy of science clarifies an understanding of the evolution of nursing
theory through paradigm science. It is important historically to understand that what we view
collectively today as nursing models and theories is the work of individuals who originally published their
ideas and conceptualizations of nursing in various areas of the country and around the world. These
works later were viewed collectively within a systematic structure of knowledge according to analysis
and evaluation (Fawcett, 1984, 1993, 2005)
 The development and use of theory led to what is recognized today as the nursing theory era
(Alligood, 201

. It was as Fitzpatrick and Whall (1983) had said, “nursing is on the brink of an exciting new era”
(p. 2). This awareness ushered in the theory utilization era.

The accomplishments of normal science accompanied the theory utilization era as emphasis
shifted to theory application in nursing practice, education, research, and administration (Alligood, 2014;
Wood, 2014). In this era, middle-range theory and the value of a nursing framework for thought and
action in nursing practice was realized. The shift in emphasis to the application of nursing theory was
extremely important for theory-based nursing, evidence-based practice, and future theory development

Practice in nursing today requires knowledge of and use of the theoretical works of the discipline
(Alligood, 2014). Not only is theory relevant in the history of nursing’s progress toward specialized
nursing knowledge, but that knowledge also contributed to recognition of nursing as a profession and a
discipline.

The achievements of the profession over the past century were highly relevant to nursing
science development, but they did not come easily. History shows that many nurses pioneered the cause
of human health and challenged the status quo with creative ideas for both the health of people and the
development of nursing.

 Nursing theoretical works represent the most comprehensive presentation of systematic nursing
knowledge and are therefore vital to the future of both the discipline and the profession of nursing.

SIGNIFICANCE OF NURSING THEORY

Significance for the Discipline

 Batey (1977) called attention to the importance of nursing conceptualization in the research
process and the role of a conceptual framework in research design for the production of
science.
  This emphasis led to the theory development era and moved nursing forward to new nursing
knowledge for nursing practice.
 Soon nursing theoretical works began to be recognized to address Batey’s call

 the discipline is dependent on theory for its continued existence—that is, nursing can be a
vocation, or nursing can be a discipline with a professional style of theory-based practice.
 The theoretical works have taken nursing to higher levels of education and practice as nurses
moved from the functional focus, with an emphasis on what nurses do, to a patient focus,
emphasizing what nurses know for thought, decision making, and action.

Significance for the Profession

Significance for the Profession Not only is theory essential for the existence of nursing as an academic
discipline, it is also vital to the practice of professional nursing

 Both Styles (1982) and Fitzpatrick (1983) referenced a detailed history specific to the
development of nursing as a profession.
 Similarities and differences may exist in sets of criteria to evaluate professions, but they all
call for a body of knowledge that is foundational to the practice of the given profession
(Styles, 1982).
 the use of substantive knowledge for theory-based evidence for nursing is a quality that is
characteristic of theory-based evidence for practice is beneficial to patients in that it guides
systematic, knowledgeable care.
 Professional nursing practice requires a systematic approach nursing as a discipline and
provide a knowledge structure for further development.
 contributes to evidence-based practice.
 nursing theory-based research is supported, it informs more nurses learn and use theory-
based practice.