This document provides an overview of the historical development of nursing theories from the 19th century to present day. It discusses Florence Nightingale's early contributions and identifies 5 stages in the evolution of nursing theory: 1) the silent knowledge stage from 1840-1950, 2) the received knowledge stage from 1950-1960, 3) the subjective knowledge stage from 1960-1970, 4) the procedural knowledge stage from 1970-1980, and 5) the constructed knowledge stage from 1990 onward. It also briefly outlines some of the major contributions of influential nursing theorists like Peplau, Henderson, Orlando, and Rogers.
2. Learning Objectives
1. Overview of previous learning
2. Discuss the historical perspectives of Nursing Theories
3. Discuss work of different nursing theorists
4. Historical perspective of nursing theories
Five stages in the development of nursing theory and philosophy:
1. Silent knowledge stage – till 1940
2. Received knowledge stage – till 1950s
3. Subjective knowledge stage – till 1960s
4. Procedural knowledge stage – 1970s and 1980s
5. Constructed knowledge stage – 1990s
6. The integrated knowledge stage – 21st century
5. Florence Nightingale
•“Notes on Nursing” published in 1859.
•In Nightingale view, nurses were to make observations of the sick
and their environment, record observations, and develop knowledge
about factors that promoted healing.
•Her framework for nursing emphasized the utility of empirical
knowledge, that knowledge developed and used by nurses should be
distinct from medical knowledge.
6. Silent knowledge stage
•Recognition of formal training of nurses
•The first training school opened in 1872 at New England Hospital in United
States.
•Most schools were under the control of hospitals.
•Managed by hospital administrators and physicians.
•Education and practice were based on apprenticeship form of education.
•Rapid growth in the number of hospital-based training programs for nurses.
•Focus was on acquisition of technical skills.
7. Cont…
•Theory was taught by physicians and practice was taught by experienced
nurses.
•Emphasis was on carrying out physicians’ orders.
•Nurses largely adhered to the medical model, which views body and mind
separately and focuses on cure and treatment of pathologic problems.
•Nurses were seen as inexpensive labor and were taught to be submissive
and obedient, and they learned to fulfill their responsibilities to physicians
without question.
•Yale University started the first autonomous school of nursing in 1924.
8. Received knowledge stage
•Serious nursing shortages the late 1940s and into the 1950s.
•Nursing education at universities was recommended as opposed to the hospital-
based training.
•Professional organizations for nurses were restructured and began to grow.
•The American Nurses Association (ANA) started programs for nursing education.
•State licensure testing for registration was started.
•Books on research methods and explicit theories of nursing began to appear.
9. Cont…
•The journal Nursing Research was first published in 1950
•In 1956, the Health Amendments Act authorized funds for financial aid to
promote graduate education for full-time study to prepare nurses for
administration, supervision, and teaching.
•Doctoral programs in nursing started originating.
•Slow but steady increase in graduate nursing education programs.
10. Subjective Knowledge Stage
•Until the 1950s, With the exceptions of Nightingale’s work nursing practice
principally derived from social, biologic, and medical theories.
•Hildegard Peplau’s book in 1952 on interpersonal process between the nurse and
the client.
•Number of nurse theorists emerged in late 1950s and 1960s
•Nurse role as leader emerged
•Provided independent conceptual framework for nursing education and practice
• Ernestine Weidenbach- Clinical Nursing: A Helping Art
• Ida Jean Orlando - Dynamic Nurse–Patient Relationship
11. Cont…
•Approaches to theory development were direct observations of practice, insights from
existing theories and other literature sources, and insights derived from explicit
philosophical perspectives about nursing and the nature of health and human experience.
•Early theories were characterized by a functional view of nursing and health. They
attempted to define what nursing is, describe the social purposes nursing serves, explain
how nurses function to realize these purposes, and identify parameters and variables that
influence illness and health.
•In the 1960s, a number of nurse leaders: Abdellah, Orlando, Widenbach, Hall, Henderson,
Levine, and Rogers developed and published their views of nursing.
•Their descriptions of nursing and nursing models evolved from their personal,
professional, and educational experiences, and reflected their perception of ideal nursing
practice.
12. Procedural Knowledge Stage
•Nursing profession was started to be viewed as a scientific discipline evolving towards a
theory based practice.
•Several nursing theory conferences were held.
•National League for Nursing implemented a requirement of conceptual frameworks for
nursing curricula led to publication of many nursing theorists beliefs and ideas about
nursing and some developed conceptual models.
•A consensus developed among nursing leaders regarding common elements of nursing:
◦ Nature of nursing (roles/actions/interventions)
◦ Individual recipient of care (client)
◦ Context of nurse–client interactions (environment)
◦ Health
13. Cont…
•Nurses debated whether there should be one conceptual model for nursing or several
models to describe the relationships among the nurse, client, environment, and
health.
•Books were written for nurses on how to critique, develop, and apply nursing theories.
•Graduate schools developed courses on analysis and application of theory, and
researchers identified nursing theories as conceptual frameworks for their studies.
•Through the late 1970s and early 1980s, theories moved to characterizing nursing’s
role from “what nurses do” to “what nursing is.” This changed nursing from a context-
dependent, reactive position to a context-independent, proactive arena
14. Constructed Knowledge Stage
•Scholars began to concentrate on theories that provide meaningful foundation
for nursing practice.
•There was a call to develop substance in theory and to focus on nursing
concepts grounded in practice and linked to research.
•The 1990s into the early 21st century saw an increasing emphasis on philosophy
and philosophy of science in nursing.
•Attention shifted from grand theories to middle range theories, as well as
application of theory in research and practice.
•The idea of evidence-based practice (EBP) was introduced to address the gap in
research and practice.
15. Cont…
Graduate education in nursing continued to grow and introduced programs of:
◦ Advanced practice nurses (APNs)
◦ Doctor of nursing practice (DNP)
The DNP was initially proposed by the American Association of Colleges of
Nursing (AACN) in 2004 to be the terminal degree for APNs.
DNP was based on recognition of the need for expanded competencies due to
the increasing complexity of clinical practice, enhanced knowledge to improve
nursing practice and outcomes, and promotion of leadership skills.
16. Integrated Knowledge Stage
•In the second decade of the 21st century, there has been significant attention to
the need to direct nursing knowledge development toward clinical relevance, to fill
“relevance gap.”
•It has been observed that, a significant portion of research supports practice
imperfectly, infrequently, and often insignificantly. The primary goal of nursing
research is to produce knowledge that supports practice.
•In the current stage of knowledge development, considerable focus is on EBP and
translational research
17. Translational research
•The idea of translational research is to close the gap between scientific
discovery and translation of research into practice; the intent is to validate
evidence in the practice setting.
•Designated a priority initiative by the National Institute of Health in 2005.
•Current stage of theory development in nursing, supports EBP and growth of
translational research.
•Development and application of middle range and practice theories will
continue to be stressed, with attention increasing on practical/clinical
application and relevance of both research and theory.
18. Historical ears of nursing knowledge
Transition from vocation to profession
Apprenticeship era
Curriculum era
Research era
Graduate education era
Theory era
Theory utilization era
21. Work of different theorists
•Florence Nightingale – Notes on Nursing
•Hildegard Peplau - Interpersonal Relations in Nursing
•Virginia Henderson – Nature of Nursing
•Abdellah - Patient-Centered Approaches to Nursing
•Ida Jean Orlando - The Dynamic Nurse–Patient Relationship
•Wiedenbach - Clinical Nursing: A Helping Art
•Lydia E. Hall – What is Nursing?
22. Work of different theorists
•Martha Rogers - Nursing: A Science of Unitary Human Beings
•Dorothea E. Orem - Nursing: Concepts of Practice
•Betty Neuman – A Health-Care Systems Model: A Total Person Approach to
Patient Problems
•Callista Roy - The Roy Adaptation Model
•Madeleine Leininger - Leininger’s Theory of Nursing: Cultural Care Diversity and
Universality
•Patricia Benner - From Novice to Expert
