Introduction to Nursing Theory: Its History, Significance, and Analysis
The systematic acquisition of knowledge is necessary for advancement in any profession… but theory and practice must be constantly interactive. “Theory is meaningless without practice, and practice is meaningless without theory” (Cross, 1981, p. 110).
The purpose of this text is to introduce the reader to nursing theorists and their work. Over the last 50 years, nursing theory has become a major theme, stimulating phenomenal growth and vast expansion of nursing education and literature. This text presents selected nursing theorists in order to expose students to a diverse range of nurse theorists and theoretical works. Many early nurses provided excellent patient care; however, much of what was known about nursing was passed down through vocational education that focused on the skillful completion of functional tasks. While many of these practices appeared to be effective, they were neither tested nor used consistently. Developing nursing knowledge to support nursing practice was a major goal set forth by nursing leaders in the twentieth century as nurses sought to improve practice and gain recognition of nursing as a profession. Nursing history clearly documents consistent efforts made toward the goal of developing a substantive body of nursing knowledge to guide nursing practice (Alligood, 2006a; Bixler & Bixler, 1959; Chinn & Kramer, 2008; George, 2002; Johnson & Webber, 2004; McEwen & Wills, 2006; Meleis, 2007; Parker, 2006).
The reader is introduced to nursing theory in three parts in this chapter: history, significance, and analysis. A brief history of nursing’s transition from vocation to profession describes the quest for nursing substance that led to this exciting period in nursing history, connecting the theory era with nursing as an academic discipline and a practice profession. Although nurse leaders worked hard in the first half of the twentieth century to gain nursing recognition as a profession, it was not until the second half of the twentieth century that leaders recognized the need for conceptual and theoretical frameworks for the development of substantive nursing knowledge and the path to professional nursing practice (Batey, 1977; Hardy, 1978). During this time, the advancement of nursing knowledge was a driving force; the baccalaureate degree became more widely accepted as the first educational level for professional nursing, and nursing achieved nationwide recognition and acceptance as an academic discipline in higher education. Nurse researchers worked to develop and clarify a substantive body of nursing knowledge with the goals of improving patient care quality, providing a professional practice style, and being recognized as a profession. In the theory utilization era, nursing history provides context for understanding the significance of nursing theory for professional nursing practice. The history and significance of nursing theory lead logically into the chapter’s final section, analysis. The analysis of nursing theoretical works and their role in knowledge development is presented as a necessary process of critical reflection required for knowledge acquisition. Criteria for analyzing theorists’ works are presented, along with a brief discussion of how each criterion helps us understand theory (Chinn & Kramer, 2008).
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NURSING THEORY’S HISTORY
Florence Nightingale is credited with establishing professional nursing. Nurses were envisioned by Nightingale as a body of educated women at a time when women were neither educated nor employed in public service. Her vision and establishment of a School of Nursing at St. Thomas’ Hospital in London marked the birth of modern nursing after her service organizing and caring for the wounded in Scutari during the Crimean War. Nightingale’s pioneering nursing practice and subsequent writings describing nursing education served as a guide for establishing nursing schools in the United States at the turn of the twentieth century (Kalisch & Kalisch, 2003; Nightingale, 1859/1969). Nursing began with a strong emphasis on practice, but nurses worked throughout the century to develop nursing as a profession through successive periods recognized as historical eras (Alligood, 2006a).
The curriculum era addressed the issue of what prospective nurses should study in order to become nurses. The emphasis at the time was on what courses nursing students should take, with the goal of developing a standardized curriculum (Alligood, 2006a). A standardized curriculum had been published by the mid-1930s. However, it was also during this time period that the concept of transferring nursing education from hospital-based diploma programs to colleges and universities emerged. Nonetheless, it took until the middle of the century for many states to start implementing this goal (Kalisch & Kalisch, 2003).
As nurses sought higher education degrees in greater numbers, the so-called research emphasis era began to emerge. This era arose as more nurses accepted higher education and came to a shared understanding of the scientific age, namely, that research is the path to new nursing knowledge. Nurses began to participate in research, and research courses were introduced into many developing graduate programs’ nursing curricula (Alligood, 2006a).
The research and graduate education eras developed concurrently. Nursing master’s degree programs arose in response to the public demand for nurses with specialized clinical nursing education. A nursing research course was included in many of these programs. During this time period, most nursing master’s programs started to include courses in concept development or nursing models, which introduced students to early nursing theorists and the knowledge development process (Alligood, 2006a).
The development of nursing knowledge is an ongoing process. Discuss the case for the ongoing development and use of nursing grand theories and conversely, make a case for the obsolescence of nursing grand theories for today’s practice and research.