Nursing followed a path from concepts to conceptual frameworks to models to theories, and ﬁ nally to middle range theory, in this theory utilization era. The early religious orders offered a respectable avenue for nuns and monks to provide care to the ill and infirm. Written observations could form the basis for a complete patient study to provide an interpretive picture of present-day nursing (“Changes in nursing practice,” 1947). This important era in the history of nursing continued to thrive and be recognized as vital to nursing’s future (Algase, 2007; Alligood, 1994; Colley, 2003; Pearson, 2007). Standardized curricula for diploma programs, Specialized knowledge and higher education, Theory-based studies for unified knowledge. These experiences cultivated and required a broad view of nursing knowledge and a desire to change the future of nursing. Tradition as a basis for nursing practice was perpetuated by the nature of apprenticeship education (Ashley, 1976). Despite social impediments to the development of nursing knowledge, nursing philosophy and ideology remained committed to the idea that nursing requires a knowledge base for practice that is distinct from that of medicine (Abdellah, 1969; Hall, 1964; Henderson, 1964, 1966; Rogers, 1970). Nursing students were presumed to learn at random through long hours of experience (with limited exposure to lectures or books) and to accept without question the prescriptions of practical techniques. An examination of nursing literature published before the 1950s is rich with detail about how nursing embodies, reflects, and requires multiple ways of knowing. As the beginning of the twentieth century drew near, nurses began to express the need for communication with other nurses to improve their practice. After these nurses were educated, they would return to nursing and conduct research, thereby contributing to nursing’s knowledge base. Duty often was expressed in religious admonitions to love, live right, and have faith; it was seen as a sacred obligation, as illustrated by a lay author who wrote that “a good nurse will die before admitting she is even tired [for] loyal service is one of the articles of the profession’s religion” (Drake, 1934, pp. After these nurses were educated, they would return to nursing and conduct research, thereby contributing to nursing’s knowledge base. Medicine, wrote Nightingale, focused on surgical and pharmacologic “cures,” which relied heavily on empiric science. Those conferences centered on nursing science and theory development and facilitated discussion of the application of knowledge from the various disciplines in nursing. Nightingale spent the first decade of her adult life tormented by a desire to use her productive capacities in a way that would benefit society. Research continued to develop during this era of graduate education; however, nurse scholars soon noted that much of the research being published lacked form and direction. During the mid-1800s, women cared for the sick as daughters, wives, mothers, or maids. Do you see the history of nursing as something important and more than just a compilation of facts about what has happened in our past? For example, Sanger developed knowledge about reproduction and birth control. After the end of World War II, many educational programs were established within institutions of higher learning, and graduate programs for nurses began to appear. They were less sophisticated with regard to method than the reports of today, but these writings changed and began to reflect the qualities of serious empiric scholarship and investigative skill. They were women of strong personal character who lived their ethical convictions that nurses can and should control nursing practice. Early authors envisioned ways for empiric knowledge to be created and displayed. Theory development with analysis and critique of syntax and the structure of theory is how knowledge development is learned in nursing doctoral programs, especially PhD, which are vital to the discipline. Start studying Historical Eras of Knowledge (Theoretical Foundations of Nursing Practice). The history of knowledge development in nursing is a vast subject indeed. . With industrialization, large populations of people moved to urban areas, and the number of hospitals increased dramatically in these areas. They wrote and published idealized views of nursing and of the type of knowledge, skills, and background needed for practice. . protection, truth telling, and imparting specialized knowledge (. The paper stems from the author's study of knowledge claims enshrined in nursing journal articles, books and conference speeches. Adah Thoms also organized a campaign to encourage members of the National Association of Colored Graduate Nurses to vote after the passage of the 19th amendment, which gave women the right to vote (Thoms, 1929/1985). Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), on The history of knowledge development in nursing, Empiric knowledge development: conceptualizing and structuring, Description and critical reflection of empiric theory, Nursing’s fundamental patterns of knowing, Confirmation and validation of empiric knowledge using research, Integrated Theory Knowledge Development in Nursing, The interpersonal process is a maturing force for the personality, Faye G. Abdellah, Irene L. Beland, Almeda Martin, and Ruth V. Matheney, The patient’s problems determine the appropriate nursing care, The interpersonal process alleviates distress, The helping process meets the patient’s needs through the art of individualizing care, Nursing care involves directing the patient toward self-love, Empathic understanding and the knowledge of the nurse help patients move toward independence, The meaning found in an illness determines how people respond, Wholism is maintained by conserving integrity, The person and the environment are energy fields that evolve negentropically, Transactions provide a frame of reference for goal setting, Josephine G. Paterson and Loretta T. Zderad, Nursing is an existential experience of nurturing, Caring is universal and varies transculturally, Caring is a moral ideal that involves mind, body, and soul engagement with another, Disease is a clue to preexisting life patterns, Individuals, as wholistic systems, interact with environmental stressors and resist disintegration by maintaining a normal line of defense, Indivisible beings and the environment co-create health, Health-promoting behavior is determined by individual characteristics and experiences as modulated by perceptions as well as interpersonal and situational factors, Caring is central to the essence of nursing; it sets up what matters, thus enabling connection and concern, and it creates the possibility for mutual helpfulness. During the period of time between about 1900 and about 1950, nurses and others were writing about nursing and patient care in the journals of the time. The conceptual frameworks of Martha Rogers, Rosemarie Parse, and Margaret Newman reflect theoretic perspectives linked to developments in modern physics that moved beyond earlier system concepts of equilibrium. The control of nursing education and practice was transferred from the profession to hospital administrators and physicians during the early 1900s, when most of the Nightingale-modeled schools in the United States were brought under the control of hospitals (Ashley, 1976). chapter. This system provided the context for rapid technologic development and a complex institutionalized system to support medical interventions. Guided by the words of Florence Nightingale and the goal of professionalism, American nurses began entering academia, first in individual courses and finally in collegiate nursing programs. Despite changes, strong evidence exists to support the claim that nurses have, throughout time, developed and used knowledge to improve practice. Johnson’s early article also challenges virtue ethics, which is a position that relies on a good person to do the right thing by differentiating ethics and morality. Nurse-scientist programs were established to enable nurses to earn doctoral degrees in other disciplines with the idea that the research skills that were learned could then be applied in nursing. By the end of the 1970s, most accredited master’s programs included courses in nursing research, clinical specialty practice, leadership, and concept development or nursing theory in a core curriculum organized with a nursing philosophy and conceptual or organizing framework. Not only did they develop health knowledge as they practiced, but they were politically committed to finding ways to distribute this knowledge to the people who needed it (Wheeler, 1985). Consistently throughout the early 20th century, nursing leaders in the United States worked together nationally and internationally in strong connecting networks and called for a social and political ethic that would restore the control of nursing practice to nurses and that would promote the health and welfare of citizens. Many early nursing conceptual frameworks and philosophies include a description of the nursing process. (p. 532). After reading this chapter you will be able to: Develop an understanding of the historical evolutions, contributions, and differences of various nursing education programs. Many have been used as a basis for curricula and as guides for practice and research. Academic institutions required faculty to hold advanced degrees and encouraged them to meet the standards of higher education with regard to providing service to the community, teaching, and performing research. It provides a historical overview essential to developing a complete understanding of the nursing profession. METHODS: A prospective cohort study analyzing the effect of a knowledge to action (KTA) education plan on nursing compliance with ERAS protocols was conducted on bedside nursing staff caring for the colorectal ERAS post-operative population using a new test instrument for pre- and post-testing. As psychologic theories of attachment and separation developed, nurses found an explanation for the problems experienced by hospitalized children and were able to change visitation practices to provide for sustained contact between parents and children. Early conceptions of nursing knowledge were grounded in a wholistic view of health and healing. 1873 – Linda Richards, the first American trained nurse, graduated from the New England Hospital for Women and Children School of Nursing. By the end of the 1970s, the number of doctorally prepared nurses in the United States had grown to nearly 2000. Pagan healers (e.g., shamans), midwives, and other folk healers linked disease to influences that came from within a spirit world. Nurses were encouraged to learn how to conduct research, developing the role for nurses for that specialized body of knowledge. Nightingale also had a great influence on nursing education; she founded St. Thomas School in London after her return from the Crimea. This article sets a direction for nursing knowledge development that is domain-driven. taking shape as a science. Nursing evolved as an art and science ; Formal nursing education and nursing service begun; Facts about Florence Nightingale. She eventually defied the wishes of her family and broke free of the oppressive social prescriptions for her life. Quality care is a prominent theme in Institute of Medicine reports, health care regulatory policies, the call for nursing education reform, and nurse researchers themselves (Benner, et al., 2010; Bigbee & Issel, 2012; Burhans & Alligood, 2010; Ellerbe & Regen, 2012; Sherwood & Barnsteiner, 2012). Economic independence for women in the United States was not possible until the mid-1900s. the question of what to teach is superfluous . also included women who bore the primary responsibility for the care of their ill family members. This was an exciting time in nursing as scholarly works of nurse scholars from across the country began to be recognized as theoretical frameworks for research and practice. According to Margaret Conrad (1947), a baccalaureate-prepared professor of nursing, this required an understanding of the laws of nature and the principles of physics, chemistry, physiology, and psychology. Women who were nurses were needed to support the war effort by providing care for the sick and wounded. Knowledge Development The focus for knowledge development in nursing has roots in Nightingale's 1859 essay, Notes on Nursing: What It Is and What It Is Not.3 She wrote, "The very elements of what constitutes good nursing are as little understood for the well as for the sick. What evolved as nursing knowledge was wisdom that came from years of experience. . The theory era, coupled with the research and graduate education eras, led to understanding of the scientific process beyond production of a scientific product (Kuhn, 1970). Even when this broad view was not explicitly mentioned in the debates (as was common during the 1970s), the broad conceptualizations labeled as theories implicitly required multiple ways of knowing. It arises from “combining instinct, knowledge and experience” (p. 162). The treatments prescribed and the continuing plan for care were also important. Her primary concern was the more pervasive plight of Victorian women. A physician who addressed the annual meeting of the Michigan Nurses Association acknowledged that scientific knowledge had increased and asked nurses to acknowledge its power and value for producing knowledge. Art in the more traditional sense was recognized as important to the art/act of nursing. The curriculum included knowledge of “the customs and laws of the hospital world which she (student) must be admonished to accept meekly” (p. 136) and “personal virtues of importance such as reticence, tact, and discretion in order that she may do no harm” (p. 136). The headings of the reviews were noted to reflect medical practice specialties as evidence of the struggle throughout nursing history to move beyond a medical view to the nursing view. nationally and internationally in strong connecting networks and called for a social and political ethic that would restore the control of nursing practice to nurses and that would promote the health and welfare of citizens. He differentiated ethics and morality. For example, some theories of learning that are applicable to classroom learning do not adequately reflect the process of learning when an individual is faced with illness, and they do not deal with the ethical issues that a nurse might face when disclosing sensitive information to a patient. The persistent dominance of science can be attributed in part to academic nurses’ need to gain legitimacy in their university communities and to nurses’ need to achieve political and personal legitimacy within medicine and society in general. Many nurse leaders were active in confronting a wide range of community-based social and health issues of the time, including temperance, freedom for enslaved people, the right of the disenfranchised to vote, and the control of venereal disease. Although nursing as a nurturing, supportive activity always has existed, it was Florence Nightingale who advocated and promoted the need for a uniformly high standard of nursing care that required both education and certain personal characteristics. This editorial further noted that “born qualities added to training” were critical for ethical conduct (p. 15). However, even during this period in nursing’s history, threads of philosophic and practical commitment to wholistic practices and to other patterns of knowing persisted. Learning OutcOmes . According to William Kilpatrick, a doctorally prepared educator, these hierarchies resulted in a “factory system that reduces individuals to a non-entity amid the bigness of the organization” (1921-1922, p. 791), Concerns about increasing levels of education at the time led two doctorally prepared academic educators to suggest that “vested interest will preclude the development of professionalism (in nursing) as hospitals will not be able to adjust to the loss of student work hours” (Bixler & Bixler, 1945, p. 732). A … Broader goals also were mentioned, such as increasing tolerance and respect by respecting the worth, autonomy, and dignity of individuals; assisting with the development of the individual; strengthening society and the Self; developing economic security; and promoting peace. Although scientific-empiric knowledge could come from disciplines outside of nursing, there was a recognition of the unique nature of nursing science. The works by Johnson (1974, 1980), King (1971), Levine (1967), Neuman (1972), Orem (1971), Rogers (1970), and Roy (1970) are evidence of the general recognition that nursing theoretical approaches were needed. Today that criterion calling for recognition of a specialized body of knowledge for nursing practice is more relevant than ever as the discipline of nursing embraces challenging changes in society and health care. How to name these theory-like constructions: theories, conceptual models, theoretic frameworks, conceptual frameworks? Would it surprise you to know that Florence Nightingale was widely known and respected for her statistical accomplishments during her lifetime? Aesthetic knowledge was gained through appreciation of the arts and by subjective sensitivity to individual differences. We have chosen to refer to these broad theory-like structures as conceptual frameworks or theoretic frameworks, and their authors we call theorists. Working with an ERAS program is a multidisciplinary challenge to improve the standard of care. Nursing diagnosis, which evolved from the nursing process and began to move nursing away from theoretic dependence on a medical model, was one method for organizing the domain of nursing practice. after one has worked for a time healing wounds which should not have been inflicted, tending ailments which should not have developed, sending patients to hospitals who need not have gone if their homes were habitable, and bringing charitable aid to persons who would not have needed it if health had not been ruined by unwholesome conditions, one longs for preventive work . Rather—and perhaps concurrent with the expansion of nursing into community-based practices—the necessity to recognize social inequalities and to take strong measures to rectify them was emphasized. It is interesting to note that courses to teach content were called fundamentals, a term that means “basic essentials,” and that the term is still used in nursing education today. Decency does not visit our common dwelling place without invitation” (p. 739). Log in Sign up. During the wars, with many men being away from their homes, women were freed from constraints and learned to manage their responsibilities in accord with their own priorities and preferences. The physician cautioned against quackery and portrayed science as a source of legitimate criteria for the selection of information provided to patients (Warnshius, 1926). Their drive for nursing knowledge led nurses and student nurses in directions that, although unclear and not fully understood at times, contributed to recognition of nursing as a learned profession. Fawcett (1984, 1989) contributed significantly to our understanding of the nature of nursing knowledge. Bond and colleagues (2011) recently researched “who uses nursing theory?” (p. 404), and reported…“increasing numbers, both in quantity and in the use of nursing theory” (p. 407). Quality care is a prominent theme in Institute of Medicine reports, health care regulatory policies, the call for nursing education reform, and nurse researchers themselves (, Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), on The Nature of Knowledge Needed for Nursing Practice, Nurse Educator conferences in Chicago (1977), Nursing Philosophies, Models, and Theories: A Focus on the Future, Areas for Further Development of Theory-Based Nursing Practice, Philosophies, Models, and Theories: Critical Thinking Structures, Newman’s Theory of Health as Expanding Consciousness in Nursing Practice, Orem’s Self-Care Deficit Theory in Nursing Practice, Nursing Models: Normal Science for Nursing Practice, Levine’s Conservation Model in Nursing Practice, Nursing Theory Utilization Application 5e.
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