Nursing Theorists Martha Raile Alligood, PhD, RN, ANEF Professor Emeritus College of Nursing

AND THEIR WORK Nursing Theorists

 

 

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AND THEIR WORK Nursing Theorists

Martha Raile Alligood, PhD, RN, ANEF Professor Emeritus College of Nursing

East Carolina University Greenville, North Carolina

 

 

3251 Riverport Lane St. Louis, Missouri 63043

NURSING THEORISTS AND THEIR WORK, EIGHTH EDITION ISBN: 978-0-323-09194-7

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Library of Congress Cataloging-in-Publication Data

Nursing theorists and their work / [edited by] Martha Raile Alligood. — Eighth edition. p. ; cm. Includes biographical references and index. ISBN 978-0-323-09194-7 9pbk. ; alk. Paper) I. Alligood, Martha Raile, editor of compilation. [DNLM: 1. Nursing Theory. 2. Models, Nursing. 3. Nurses—Biography. Philosophy, Nursing. WY 86] RT84.5 610.7301—dc23

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Dedicated to the memory of my mother: Winifred Havener Raile, RN

1914-2012 Class of 1936,

Good Samaritan School of Nursing, Zanesville, Ohio

 

 

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Contributors

Herdis Alvsvåg, RN, Cand Polit Associate Professor Department of Education and Health Promotion University of Bergen Bergen, Norway; Associate Professor II Bergen Deaconess University College Bergen, Norway

Donald E. Bailey, Jr., PhD, RN Associate Professor School of Nursing Duke University Durham, North Carolina

Barbara Banfield, RN, PhD Farmington Hills, Michigan

Violeta A. Berbiglia, EdD, MSN, RN Associate Professor, Retired The University of Texas Health Science Center

at San Antonio School of Nursing San Antonio, Texas

Debra A. Bournes, RN, PhD Director of Nursing New Knowledge and Innovation University Health Network Toronto, Canada

Nancy Brookes, PhD, RN, BC, MSc (A), CPMHN (C) Nurse Scholar and Adjunct Professor Royal Ottawa Health Care Group Royal Ottawa Mental Health Centre University of Ottawa Faculty of Health Sciences Ottawa, Ontario, Canada

Janet Witucki Brown, PhD, RN, CNE Associate Professor College of Nursing University of Tennessee Knoxville, Tennessee

Karen A. Brykczynski, PhD, RN, FNP-BC, FAANP, FAAN Professor School of Nursing at Galveston The University of Texas Medical Branch Galveston, Texas

Sherrilyn Coffman, PhD, RN Professor and Assistant Dean School of Nursing Nevada State College Henderson, Nevada

Doris Dickerson Coward, RN, PhD Associate Professor, Retired School of Nursing The University of Texas at Austin Austin, Texas

Thérèse Dowd, PhD, RN, HTCP Associate Professor Emeritus College of Nursing The University of Akron Akron, Ohio

Nellie S. Droes, DNSc, RN Associate Professor, Emerita College of Nursing East Carolina University Greenville, North Carolina

 

 

Contributorsviii

Margaret E. Erickson, PhD, RN, CNS, AHN-BC Executive Director American Holistic Nurses’ Certification Corporation Cedar Park, Texas

Mary E. Gunther, RN, MSN, PhD Associate Professor College of Nursing University of Tennessee Knoxville, Tennessee

Dana M. Hansen, RN, MSN, PhD Assistant Professor College of Nursing Kent State University Kent, Ohio

Sonya R. Hardin, PhD, RN, CCRN, NP-C Professor College of Nursing East Carolina University Greenville, North Carolina

Robin Harris, PhD, ANP-BC, ACNS-BC Nurse Practitioner Wellmont CVA Heart Institute Kingsport, Tennessee

Patricia A. Higgins, PhD, RN Assistant Professor Frances Payne Bolton School of Nursing Case Western Reserve University Cleveland, Ohio

Bonnie Holaday, DNS, RN, FAAN Professor and Director, Graduate Studies School of Nursing and Institute on Family and

Neighborhood Life Clemson University Clemson, South Carolina

Eun-Ok Im, PhD, MPH, RN, CNS, FAAN Professor and Marjorie O. Rendell Endowed

Professor School of Nursing The University of Pennsylvania Philadelphia, Pennsylvania

D. Elizabeth Jesse, PhD, RN, CNM Associate Professor College of Nursing East Carolina University Greenville, North Carolina

Lisa Kitko, PhD, RN, CCRN Assistant Professor School of Nursing The Pennsylvania State University University Park, Pennsylvania

Theresa Gunter Lawson, PhD, APRN, FNP-BC Assistant Professor Department of Nursing Lander University Greenwood, South Carolina

Unni Å. Lindström, PhD, RN Professor Department of Caring Science Faculty of Social and Caring Sciences Åbo Academy University Vasa, Finland

M. Katherine Maeve, PhD, RN Nurse Researcher Charlie Norwood VAMC Augusta, Georgia

Marilyn R. McFarland, PhD, RN, FNP, BC, CTN Associate Professor of Nursing and Family Nurse

Practitioner Urban Health and Wellness Center University of Michigan Flint, Michigan

Gwen McGhan, PhD(c), RN Jonas/Hartford Doctoral Scholar School of Nursing The Pennsylvania State University University Park, Pennsylvania

Molly Meighan, RNC, PhD Professor Emerita Division of Nursing Carson-Newman College Jefferson City, Tennessee

 

 

Contributors ix

Patricia R. Messmer, PhD, RN-BC, FAAN Director Patient Care Services Research Children’s Mercy Hospital and Clinics Kansas City, Missouri

Gail J. Mitchell, PhD, RN, MScN, BScN Professor School of Nursing Chair/Director York-UHN Nursing Academy York University Toronto, Ontario, Canada

Lisbet Lindholm Nyström, PhD, RN Associate Professor Department of Caring Science Faculty of Social and Caring Sciences Åbo Academy University Vasa, Finland

Janice Penrod, PhD, RN, FGSA, FAAN Director, Center for Nursing Research Associate Professor School of Nursing The Pennsylvania State University University Park, Pennsylvania

Susan A. Pfettscher, DNSc, RN Retired Bakersfield, California

Kenneth D. Phillips, PhD, RN Professor and Associate Dean for Research and

Evaluation College of Nursing The University of Tennessee Knoxville, Tennessee

Marie E. Pokorny, PhD, RN Director of the PhD Program College of Nursing East Carolina University Greenville, North Carolina

Marguerite J. Purnell, PhD, RN, AHN-BC Assistant Professor Christine E. Lynn College of Nursing Florida Atlantic University Boca Raton, Florida

Teresa J. Sakraida, PhD, RN Assistant Professor College of Nursing University of Colorado, Denver Aurora, Colorado

Karen Moore Schaefer, PhD, RN Associate Chair and Associate Professor, Retired Department of Nursing College of Health Professions Temple University Philadelphia, Pennsylvania

Ann M. Schreier, PhD, RN Associate Professor College of Nursing East Carolina University Greenville, North Carolina

Carrie J. Scotto, PhD, RN Associate Professor College of Nursing University of Akron Akron, Ohio

Christina L. Sieloff, PhD, RN, NE, BC Associate Professor College of Nursing Montana State University Billings, Montana

Janet L. Stewart, PhD, RN Assistant Professor Department of Health Promotion and Development School of Nursing University of Pittsburgh Pittsburgh, Pennsylvania

 

 

Contributorsx

Danuta M. Wojnar, PhD, RN, MEd, IBCLC Assistant Professor College of Nursing Seattle University Seattle, Washington

Joan E. Zetterlund, PhD, RN Professor Emerita of Nursing School of Nursing North Park University Chicago, Illinois

 

 

xi

Jean Logan, RN, PhD Professor Grand View University Des Moines, Iowa

Karen Pennington, PhD, RN Associate Professor Regis University Denver, Colorado

Reviewers

Nancy Stahl, RN, MSN, CNE Associate Professor BSN Coordinator University of North Georgia Dahlonega, Georgia

 

 

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About the Editor

Martha Raile Alligood is professor emeritus at East Carolina University College of Nursing in Greenville, North Carolina, where she was Director of the Nursing PhD program. A graduate of Good Samaritan School of Nursing, she also holds a bachelor of sacred literature (BSL) from Johnson University, a BSN from University of Virginia, an MS from The Ohio State University, and a PhD from New York University.

Her career in nursing education began in Zimbabwe (formerly Rhodesia) in Africa and has included graduate appointments at the University of Florida, University of South Carolina, and University of Tennessee. Among her professional memberships are Epsilon and Beta Nu Chapters of Sigma Theta Tau International (STTI), Southern Nursing Research Society (SNRS), North Carolina Nurses Association/American Nurses Association (NCNA/ANA), and Society of Rogerian Scholars (SRS).

A recipient of numerous awards and honors, she is a Fellow of the National League for Nursing (NLN) Acad- emy of Nursing Education, received the SNRS Leadership in Research Award, and was honored with the East Carolina University Chancellors’s Women of Distinction Award. A member of the Board of Trustees at Johnson University, Dr. Alligood chairs the Academic Affairs Committee.

She served as contributing editor for the Theoretical Concerns column in Nursing Science Quarterly, Vol. 24, 2011, and is author/editor of Nursing Theory: Utilization & Application, fifth edition, as well as this eighth edition of Nursing Theorists and Their Work.

 

 

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This book is a tribute to nursing theorists and a classic in theoretical nursing literature. It presents many major thinkers in nursing, reviews their important knowledge-building ideas, lists their publications, and points the reader to those using the works and writing about them in their own theoretical publications. Unit I introduces the text with a brief history of nursing knowledge development and its significance to the

discipline and practice of the profession in Chapter 1. Other chapters in Unit I discuss the history, philosophy of science and the framework for analysis used throughout the text, logical reasoning and theory development processes, and the structure of knowledge and types of knowledge within that structure. Ten works from earlier editions of Nursing Theorists and Their Work are introduced and discussed briefly as nursing theorists of historical significance in Chapter 5. They are Peplau; Henderson; Abdellah; Wiedenbach; Hall; Travelbee; Barnard; Adam; Roper, Logan, Tierney, and Orlando.

In Unit II, the philosophies of Nightingale, Watson, Ray, Benner, Martinsen, and Eriksson are presented. Unit III includes nursing models by Levine, Rogers, Orem, King, Neuman, Roy, and Johnson. The work of Boykin and Schoenhofer begins Unit IV on nursing theory, followed by the works of Meleis; Pender; Leininger; Newman; Parse; Erickson, Tomlin, and Swain; and the Husteds. Unit V presents middle range theoretical works of Mercer; Mishel; Reed; Wiener and Dodd; Eakes, Burke, and Hainsworth; Barker; Kolcaba; Beck; Swanson; Ruland and Moore. Unit VI addresses the state of the art and science of nursing theory from three perspectives: the philosophy of nursing science, the expansion of theory development, and the global nature and expanding use of nursing theoretical works.

The works of nurse theorists from around the world are featured in this text, including works by international theorists that have been translated into English. Nursing Theorists and Their Work has also been translated into numerous languages for nursing faculty and students in other parts of the world as well as nurses in practice.

Nurses and students at all stages of their education are interested in learning about nursing theory and the use of nurse theorist works from around the world. Those who are just beginning their nursing education, such as associate degree and baccalaureate students, will be interested in the concepts, definitions, and theoreti- cal assertions. Graduate students, at the masters and doctoral levels, will be more interested in the logical form, acceptance by the nursing community, the theoretical sources for theory development, and the use of empirical data. The references and extensive bibliographies are particularly useful to graduate students for locating primary and secondary sources that augment the websites specific to the theorist. The following comprehensive websites are excellent resources with information about theory resources and links to the individual theorists featured in this book:

• Nursing Theory link page, Clayton College and State University, Department of Nursing: http: //www. healthsci.clayton.edu/eichelberger/nursing.htm

• Nursing Theory page, Hahn School of Nursing and Health Science, University of San Diego: http: //www. sandiego.edu/academics/nursing/theory/

• A comprehensive collection of nursing theory media, The Nurse Theorists: Portraits of Excellence, Vol. I and Vol. II and Nurse Theorists: Excellence in Action: http: //www.fitne.net/

The works of the theorists presented in this text have stimulated phenomenal growth in nursing literature and enriched the professional lives of nurses around the world by guiding nursing research, education, administra- tion, and practice. The professional growth continues to multiply as we analyze and synthesize these works,

Preface

 

 

Prefacexiv

generate new ideas, and develop new theory and applications for education in the discipline and quality care in practice by nurses.

The work of each theorist is presented with a framework using the following headings to facilitate uniformity and comparison among the theorists and their works:

• Credentials and background • Theoretical sources for theory development • Use of empirical data • Major concepts and definitions • Major assumptions • Theoretical assertions • Logical form • Acceptance by the nursing community • Further development • Critique of the work • Summary • Case study based on the work • Critical thinking activities • Points for further study • References and bibliographies

Acknowledgments I am very thankful to the theorists who critiqued the original and many subsequent chapters about themselves to keep the content current and accurate. The work of Paterson and Zderad was omitted at their request.

I am very grateful to those who have contributed or worked behind the scenes with previous editions to develop this text over the years. In the third edition, Martha Raile Alligood joined Ann Marriner Tomey, to reorder the chapters, serve as a contributing author, and edit for consistency with the new organization of the text. Subsequently Dr. Tomey recommended Dr. Alligood to Mosby-Elsevier to design and coedit a practice focused text, Nursing Theory: Utilization and Application and based on Alligood’s expertise in nursing theory, invited her to become coeditor and contributing author to future editions of this text, Nursing Theorists and Their Work. I want to recognize and thank Ann Marriner Tomey for her vision to develop the first six editions of this book. Her mentorship, wisdom, and collegial friendship have been special to me in my professional career. Most of all, she is to be commended for her dedication to this text that continues to make an important and valuable contribution to the discipline and the profession of nursing. I wish Ann well in her retirement.

Finally, I would like to thank the publishers at Mosby-Elsevier for their guidance and assistance through the years to bring this text to this eighth edition. The external reviews requested by Mosby-Elsevier editors have contributed to the successful development of each new edition. The chapter authors who over the years have contributed their expert knowledge of the theorists and their work continue to make a most valuable contribution.

Martha Raile Alligood

 

 

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UNIT I Evolution of Nursing Theories 1 Introduction to Nursing Theory: Its History, Significance, and Analysis, 2 Martha Raile Alligood

2 History and Philosophy of Science, 14 Sonya R. Hardin

3 Theory Development Process, 23 Sonya R. Hardin

4 The Structure of Specialized Nursing Knowledge, 38 Martha Raile Alligood

5 Nursing Theorists of Historical Significance, 42 Marie E. Pokorny

Hildegard E. Peplau Virginia Henderson Faye Glenn Abdellah Ernestine Wiedenbach Lydia Hall Joyce Travelbee Kathryn E. Barnard Evelyn Adam Nancy Roper, Winifred W. Logan, and Alison J. Tierney Ida Jean (Orlando) Pelletier

UNIT II Nursing Philosophies 6 Florence Nightingale: Modern Nursing, 60 Susan A. Pfettscher

7 Jean Watson: Watson’s Philosophy and Theory of Transpersonal Caring, 79 D. Elizabeth Jesse and Martha R. Alligood

8 Marilyn Anne Ray: Theory of Bureaucratic Caring, 98 Sherrilyn Coffman

9 Patricia Benner: Caring, Clinical Wisdom, and Ethics in Nursing Practice, 120 Karen A. Brykczynski

10 Kari Martinsen: Philosophy of Caring, 147 Herdis Alvsvåg

11 Katie Eriksson: Theory of Caritative Caring, 171 Unni Å. Lindström, Lisbet Lindholm Nyström, and Joan E. Zetterlund

Contents

 

 

Contentsxvi

UNIT III Nursing Conceptual Models 12 Myra Estrin Levine: The Conservation Model, 204 Karen Moore Schaefer

13 Martha E. Rogers: Unitary Human Beings, 220 Mary E. Gunther

14 Dorothea E. Orem: Self-Care Deficit Theory of Nursing, 240 Violeta A. Berbiglia and Barbara Banfield

15 Imogene M. King: Conceptual System and Middle-Range Theory of Goal Attainment, 258 Christina L. Sieloff and Patricia R. Messmer

16 Betty Neuman: Systems Model, 281 Theresa G. Lawson

17 Sister Callista Roy: Adaptation Model, 303 Kenneth D. Phillips and Robin Harris

18 Dorothy E. Johnson: Behavioral System Model, 332 Bonnie Holaday

UNIT IV Nursing Theories 19 Anne Boykin and Savina O. Schoenhofer: The Theory of Nursing as Caring: A Model for

Transforming Practice, 358 Marguerite J. Purnell

20 Afaf Ibrahim Meleis: Transitions Theory, 378 Eun-Ok Im

21 Nola J. Pender: Health Promotion Model, 396 Teresa J. Sakraida

22 Madeleine M. Leininger: Culture Care Theory of Diversity and Universality, 417 Marilyn R. McFarland

23 Margaret A. Newman: Health as Expanding Consciousness, 442 Janet Witucki Brown and Martha Raile Alligood

24 Rosemarie Rizzo Parse: Humanbecoming, 464 Debra A. Bournes and Gail J. Mitchell

25 Helen C. Erickson, Evelyn M. Tomlin, Mary Ann P. Swain: Modeling and Role-Modeling, 496

Margaret E. Erickson

26 Gladys L. Husted and James H. Husted: Symphonological Bioethical Theory, 520 Carrie Scotto

UNIT V Middle Range Nursing Theories 27 Ramona T. Mercer: Maternal Role Attainment—Becoming a Mother, 538 Molly Meighan

28 Merle H. Mishel: Uncertainty in Illness Theory, 555 Donald E. Bailey, Jr. and Janet L. Stewart

 

 

Contents xvii

29 Pamela G. Reed: Self-Transcendence Theory, 574 Doris D. Coward

30 Carolyn L. Wiener and Marylin J. Dodd: Theory of Illness Trajectory, 593 Janice Penrod, Lisa Kitko, and Gwen McGhan

31 Georgene Gaskill Eakes, Mary Lermann Burke, and Margaret A. Hainsworth: Theory of Chronic Sorrow, 609

Ann M. Schreier and Nellie S. Droes

32 Phil Barker: The Tidal Model of Mental Health Recovery, 626 Nancy Brookes

33 Katharine Kolcaba: Theory of Comfort, 657 Thérèse Dowd

34 Cheryl Tatano Beck: Postpartum Depression Theory, 672 M. Katherine Maeve

35 Kristen M. Swanson: Theory of Caring, 688 Danuta M. Wojnar

36 Cornelia M. Ruland and Shirley M. Moore: Peaceful End-of-Life Theory, 701 Patricia A. Higgins and Dana M. Hansen

UNIT VI The Future of Nursing Theory 37 State of the Art and Science of Nursing Theory, 712 Martha Raile Alligood

Index, 721

 

 

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n Searching for specialized nursing knowledge led nurse scholars to theories that guide research, education, administration, and professional practice.

n Nursing followed a path from concepts to conceptual frameworks to models to theories, and finally to middle range theory, in this theory utilization era.

n Nursing history demonstrates the significance of theory for nursing as a division of education (the discipline) and a specialized field of practice (the profession).

n Knowledge of the theory development process is basic to a personal understanding of the theoretical works of the discipline.

n Analysis facilitates learning through systematic review and critical reflection of the theoretical works of the discipline.

n Theory analysis begins the process of identifying a decision making framework for nursing research or nursing practice.

Evolution of Nursing Theories

U N I T I

 

 

2

“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).

Introduction to Nursing Theory: Its History, Significance, and Analysis

Martha Raile Alligood

C H A P T E R 1

Bixler, 1959; Chinn & Kramer, 2011; George, 2011; Im & Chang, 2012; Judd, Sitzman & Davis, 2010; Meleis, 2007; Shaw, 1993).

This text is designed to introduce the reader to nursing theorists and their work. Nursing theory became a major theme in the last century, and it con- tinues today to stimulate phenomenal professional growth and expansion of nursing literature and edu- cation. Selected nursing theorists are presented in this text to expose students at all levels of nursing to a broad range of nurse theorists and various types of theoretical works. Nurses of early eras delivered excellent care to patients; however, much of what was known about nursing was passed on through forms of education that were focused on skills and functional tasks. Whereas many nursing practices seemed effective, they were not tested nor used uni- formly in practice or education. Therefore, a major goal put forth by nursing leaders in the twentieth century was the development of nursing knowledge on which to base nursing practice, improve quality of care, and gain recognition of nursing as a profession. The history of nursing clearly documents sustained efforts toward the goal of developing a specialized body of nursing knowledge to guide nursing practice (Alligood, 2010a; Alligood & Tomey, 1997; Bixler &

Previous authors: Martha Raile Alligood, Elizabeth Chong Choi, Juanita Fogel Keck, and Ann Marriner Tomey.

This chapter introduces nursing theory from three different perspectives: history, significance, and anal- ysis. Each perspective contributes understanding of the contributions of the nursing theorists and their work. A brief history of nursing development from vocational to professional describes the search for nursing substance that led to this exciting time in nursing history as linkages were strengthened be- tween nursing as an academic discipline and as pro- fessional practice. The history of this development provides context and a perspective to understand the continuing significance of nursing theory for the dis- cipline and profession of nursing. The history and significance of nursing theory leads logically into analysis, the third section of the chapter and final perspective. Analysis of nursing theoretical works and its role in knowledge development is presented as an essential process of critical reflection. Criteria for analysis of the works of theorists are presented, along with a brief discussion of how each criterion

 

 

CHAPTER 1 Introduction to Nursing Theory: Its History, Significance, and Analysis 3

and individual hospital procedure manuals (Alligood, 2010a; Kalisch & Kalisch, 2003). Although some nurs- ing leaders aspired for nursing to be recognized as a profession and become an academic discipline, nursing practice continued to reflect its vocational heritage more than a professional vision. The transition from vocation to profession included successive eras of his- tory as nurses began to develop a body of specialized knowledge on which to base nursing practice. Nurs- ing had begun with a strong emphasis on practice, and nurses worked throughout the century toward the development of nursing as a profession. Progress toward the goal of developing a specialized basis for nursing practice has been viewed from the perspec- tive of historical eras recognizing the thrust toward professional development within each era (Alligood, 2010a; Alligood & Tomey, 1997).

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 (Alligood, 2010a). By the mid-1930s, a standardized curriculum had been published and adopted by many diploma programs. However, the idea of moving nursing edu- cation from hospital-based diploma programs into colleges and universities also emerged during this era (Judd, Sitzman & Davis, 2010). In spite of this early idea for nursing education, it was the middle of the century before many states acted upon this goal, and during the second half of the twentieth century, diploma programs began closing and significant numbers of nursing education programs opened in colleges and universities (Judd, Sitzman, & Davis, 2010; Kalisch & Kalisch, 2003). The curriculum era emphasized course selection and content for nursing programs and gave way to the research era, which focused on the research process and the long-range goal of acquiring substantive knowledge to guide nursing practice.

As nurses increasingly sought degrees in higher education, the research emphasis era began to emerge. This era began during the mid-century as more nurse leaders embraced higher education and arrived at a common understanding of the scientific age—that research was the path to new nursing knowledge. Nurses began to participate in research, and research courses were included in the nursing curricula of early

contributes to a deeper understanding of the work (Chinn & Kramer, 2011).

History of Nursing Theory The history of professional nursing began with Flor- ence Nightingale. Nightingale envisioned nurses as a body of educated women at a time when women were neither educated nor employed in public service. Following her wartime service of organizing and car- ing 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 pioneering activities in nursing practice and education and her subsequent writings became a guide for establishing nursing schools and hospitals in the United States at the beginning of the twentieth century (Kalisch & Kalisch, 2003; Nightingale, 1859/1969).

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 (Alligood, 2010a, 2010b; Alligood & Tomey, 2010; Bixler & Bixler, 1959; Chinn & Kramer, 2011; Fawcett, 2005; Im & Chang, 2012; Walker & Avant, 2011). It was during the mid-1800s that Night- ingale recognized the unique focus of nursing and declared nursing knowledge as distinct from medical 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 follow- ing: that care of the sick is based on knowledge of persons and their surroundings—a different knowl- edge base than that used by physicians in their prac- tice (Nightingale, 1859/1969). Despite this early edict from Nightingale in the 1850s, it was 100 years later, during the 1950s, before the nursing profession began to engage in serious discussion of the need to develop nursing knowledge apart from medical knowledge to guide nursing practice. This beginning led to aware- ness of the need to develop nursing theory (Alligood, 2010a; Alligood, 2004; Chinn & Kramer, 2011; Meleis, 2007; Walker & Avant, 2011). Until the emergence of nursing as a science in the 1950s, nursing practice was based on principles and traditions that were handed down through an apprenticeship model of education

 

 

UNIT I Evolution of Nursing Theories4

developing graduate nursing programs (Alligood, 2010a). In the mid-1970s, an evaluation of the first 25 years of the journal Nursing Research revealed that nursing studies lacked conceptual connections and theoretical frameworks, accentuating the need for conceptual and theoretical frameworks for develop- ment of specialized nursing knowledge (Batey, 1977). Awareness of the need for concept and theory devel- opment coincided with two other significant mile- stones in the evolution of nursing theory. The first milestone is the standardization of curricula for nurs- ing master’s education by the National League for Nursing accreditation criteria for baccalaureate and higher-degree programs, and the second is the deci- sion that doctoral education for nurses should be in nursing (Alligood, 2010a).

The research era and the graduate education era developed in tandem. Master’s degree programs in nursing emerged across the country to meet the pub- lic 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 pro- grams began to include courses in concept develop- ment and nursing models, introducing students to early nursing theorists and knowledge development processes (Alligood, 2010a). Development of nursing knowledge was a major force during this period. The baccalaureate degree began to gain wider acceptance as the first educational level for professional nursing, and nursing attained nationwide recognition and acceptance as an academic discipline in higher edu- cation. 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 achiev- ing recognition as a profession. There were debates and discussions in the 1960s regarding the proper direction and appropriate discipline for nursing knowledge development. In the 1970s, nursing con- tinued to make the transition from vocation to pro- fession as nurse leaders debated whether nursing should be other-discipline based or nursing based. History records the outcome, that nursing practice is to be based on nursing science (Alligood, 2010a; Fawcett, 1978; Nicoll, 1986). It is as Meleis (2007) noted, “theory is not a luxury in the discipline of nursing . . . but an integral part of the nursing lexicon

in education, administration, and practice” (p. 4). An important precursor to the theory era was the gen- eral acceptance of nursing as a profession and an academic discipline in its own right.

The theory era was a natural outgrowth of the re- search and graduate education eras (Alligood, 2010a; Im & Chang, 2012). The explosive proliferation of nursing doctoral programs from the 1970s and nursing theory literature substantiated that nursing doctorates should be in nursing (Nicoll, 1986, 1992, 1997; Reed, Shearer, & Nicoll, 2003; Reed & Shearer, 2009; 2012). As understanding of research and knowledge development increased, it became obvi- ous that research without conceptual and theoretical frameworks produced isolated information. Rather, there was an understanding that research and theory together were required to produce nursing science (Batey, 1977; Fawcett, 1978; Hardy, 1978). Doctoral education in nursing began to flourish with the introduction of new programs and a strong emphasis on theory development and testing. The theory era accelerated as works began to be recognized as theory, having been developed as frameworks for curricula and advanced practice guides. In fact, it was at the Nurse Educator Conference in New York City in 1978 that theorists were recognized as nurs- ing theorists and their works as nursing conceptual models and theories (Fawcett, 1984; Fitzpatrick & Whall, 1983).

The 1980s was a period of major developments in nursing theory that has been characterized as a tran- sition from the pre-paradigm to the paradigm period (Fawcett, 1984; Hardy, 1978; Kuhn, 1970). The pre- vailing nursing paradigms (models) provided per- spectives for nursing practice, administration, educa- tion, research, and further theory development. In the 1980s, Fawcett’s seminal proposal of four global nursing concepts as a nursing metaparadigm served as an organizing structure for existing nursing frame- works and introduced a way of organizing individual theoretical works in a meaningful structure (Fawcett, 1978, 1984, 1993; Fitzpatrick & Whall, 1983). Clas- sifying the nursing models as paradigms within a metaparadigm of the person, environment, health, and nursing concepts systematically united the nurs- ing theoretical works for the discipline. This system clarified and improved comprehension of knowledge development by positioning the theorists’ works in a

 

 

CHAPTER 1 Introduction to Nursing Theory: Its History, Significance, and Analysis 5

larger context, thus facilitating the growth of nursing science (Fawcett, 2005). The body of nursing science and research, education, administration, and prac- tice continues to expand through nursing scholar- ship. In the last decades of the century, emphasis shifted from learning about the theorists to utiliza- tion of the theoretical works to generate research questions, guide practice, and organize curricula. Evidence of this growth of theoretical works has pro- liferated in podium presentations at national and international conferences, newsletters, journals, and books written by nurse scientists who are members of societies as communities of scholars for nursing models and theories. Members contribute to the gen- eral nursing literature and communicate their re- search and practice with a certain paradigm model or framework at conferences of the societies where they present their scholarship and move the science of the selected paradigm forward (Alligood, 2004; Alligood 2014, in press; Fawcett & Garity, 2009; Im & Chang, 2012; Parker, 2006).

These observations of nursing theory develop- ment bring Kuhn’s (1970) description of normal science to life. His philosophy of science clarifies our understanding of the evolution of nursing theory through paradigm science. It is important histori- cally to understand that what we view collectively today as nursing models and theories is the work of individuals in various areas of the country who pub- lished their ideas and conceptualizations of nursing. These works later were viewed collectively within a systematic structure of knowledge according to analysis and evaluation (Fawcett, 1984, 1993, 2005). Theory development emerged as a process and prod- uct of professional scholarship and growth among nurse leaders, administrators, educators, and practi- tioners who sought higher education. These leaders recognized limitations of theory from other disci- plines to describe, explain, or predict nursing out- comes, and they labored to establish a scientific basis for nursing management, curricula, practice, and research. The development and use of theory con- veyed meaning for nursing processes, resulting in what is recognized today as the nursing theory era (Alligood, 2010a; Alligood 2010b; Nicoll, 1986, 1992, 1997; Reed, Shearer, & Nicoll, 2003; Reed & Shearer, 2012; Wood, 2010). 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 accompa- nied the theory utilization era as emphasis shifted to theory application in nursing practice, education, administration, and research (Alligood, 2010c; Wood, 2010). In this era, middle-range theory and valuing of a nursing framework for thought and action of nursing practice was realized. This shift to the appli- cation of nursing theory was extremely important for theory-based nursing, evidence-based practice, and future theory development (Alligood, 2011a; Alligood, 2014, in press; Alligood & Tomey, 2010; Alligood & Tomey, 1997, 2002, 2006; Chinn & Kramer, 2011; Fawcett, 2005; Fawcett & Garity, 2009).

The theory utilization era has restored a balance between research and practice for knowledge devel- opment in the discipline of nursing. The reader is referred to the fifth edition of Nursing Theory: Utili- zation & Application (Alligood, 2014, in press) for case applications and evidence of outcomes from utilization of nursing theoretical works in practice. Table 1-1 presents a summary of the eras of nursing’s search for specialized nursing knowledge. Each era addressed nursing knowledge in a unique way that contributed to the history. Within each era, the per- vading question “What is the nature of the knowl- edge that is needed for the practice of nursing?” was addressed at a level of understanding that prevailed at the time (Alligood, 2010a).

This brief history provides some background and context for your study of nursing theorists and their work. The theory utilization era continues today, emphasizing the development and use of nursing theory and producing evidence for professional practice. New theory and new methodologies from qualitative research approaches continue to expand ways of knowing among nurse scientists. The utili- zation of nursing models, theories, and middle- range theories for the thought and action of nursing practice contributes important evidence for quality care in all areas of practice in the twenty-first century (Alligood, 2010b; Fawcett, 2005; Fawcett & Garity, 2009; Peterson, 2008; Smith & Leihr, 2008; Wood, 2010). Preparation for practice in the pro- fession of nursing today requires knowledge of and use of the theoretical works of the discipline (Alligood, 2010c).

 

 

UNIT I Evolution of Nursing Theories6

Significance of Nursing Theory At the beginning of the twentieth century, nursing was not recognized as an academic discipline or a profession. The accomplishments of the past century led to the recognition of nursing in both areas. The terms discipline and profession are interrelated, and some may even use them interchangeably; however they are not the same. It is important to note their differences and specific meaning, as noted in Box 1-1:

The achievements of the profession over the past century were highly relevant to nursing science devel- opment, but they did not come easily. History shows that many nurses pioneered the various causes and challenged the status quo with creative ideas for both the health of people and the development of nursing. Their achievements ushered in this exciting time when nursing became recognized as both an aca- demic discipline and a profession (Fitzpatrick, 1983; Kalisch & Kalisch, 2003; Meleis, 2007; Shaw, 1993). This section addresses the significance of theoretical works for the discipline and the profession of nursing. Nursing theoretical works represent the most com- prehensive presentation of systematic nursing knowl- edge; therefore, nursing theoretical works are vital to the future of both the discipline and the profession of nursing.

Significance for the Discipline Nurses entered baccalaureate and higher-degree programs in universities during the last half of the twentieth century, and the goal of developing knowl- edge as a basis for nursing practice began to be real- ized. University baccalaureate programs proliferated, master’s programs in nursing were developed, and

TA B L E 1-1 Historical Eras of Nursing’s Search for Specialized Knowledge

Historical Eras Major Question Emphasis Outcomes Emerging Goal

Curriculum Era:

1900 to 1940s

What curriculum content should student nurses study to be nurses?

Courses included in nursing programs

Standardized curricula for diploma programs

Develop specialized knowledge and higher education

Research Era: 1950 to 1970s

What is the focus for nursing research?

Role of nurses and what to research

Problem studies and studies of nurses

Isolated studies do not yield unified knowledge

Graduate Edu- cation Era:

1950 to 1970s

What knowledge is needed for the practice of nursing?

Carving out an advanced role and basis for nursing practice

Nurses have an impor- tant role in health care

Focus graduate educa- tion on knowledge development

Theory Era: 1980 to 1990s

How do these frame- works guide research and practice?

There are many ways to think about nursing

Nursing theoretical works shift the focus to the patient

Theories guide nursing research and practice

Theory Utilization Era: Twenty-first

Century

What new theories are needed to produce evidence of quality care?

Nursing theory guides research, practice, education, and administration

Middle-range theory may be from quanti- tative or qualitative approaches

Nursing frameworks produce knowledge (evidence) for quality care

Alligood, M. R. (2014, in press). Nursing theory: Utilization & application. Maryland Heights, (MO): Mosby-Elsevier.

n A discipline is specific to academia and refers to a branch of education, a department of learning, or a domain of knowledge.

n A profession refers to a specialized field of prac- tice, founded upon the theoretical structure of the science or knowledge of that discipline and accompanying practice abilities.

B OX 1-1 The Meaning of a Discipline and a Profession

Data from Donaldson, S. K., & Crowley, D. M. (1978). The discipline of nursing. Nursing Outlook, 26(2), 1113–1120.; Orem, D. (2001). Nursing: Concepts of practice (6th ed.). St. Louis: Mosby.; Styles, M. M. (1982). On nursing: Toward a new endowment. St. Louis: Mosby.

 

 

CHAPTER 1 Introduction to Nursing Theory: Its History, Significance, and Analysis 7

a standardized curriculum was realized through accreditation. Nursing had passed through eras of gradual development, and nursing leaders offered their perspectives on the development of nursing sci- ence. They addressed significant disciplinary ques- tions about whether nursing was an applied science or a basic science (Donaldson & Crowley, 1978; Johnson, 1959; Rogers, 1970). History provides evidence of the consensus that was reached, and nursing doctoral programs began to open to generate nursing knowledge.

The 1970s was a significant period of development. In 1977, after Nursing Research had been published for 25 years, studies were reviewed comprehensively, and strengths and weaknesses were reported in the journal that year. Batey (1977) called attention to the impor- tance of nursing conceptualization in the research process and the role of a conceptual framework in the design of research for the production of science. This emphasis led the theory development era and moved nursing forward to new nursing knowledge for nursing practice. Soon the nursing theoretical works began to be recognized to address Batey’s call (Johnson, 1968, 1974; King, 1971; Levine, 1969; Neuman, 1974; Orem, 1971; Rogers, 1970; Roy, 1970).

In 1978, Fawcett presented her double helix meta- phor, now a classic publication, on the interdependent relationship of theory and research. Also at this time, nursing scholars such as Henderson, Nightingale, Orlando, Peplau, and Wiedenbach were recognized for the theoretical nature of their earlier writings. These early works were developed by educators as frameworks to structure curriculum content in nurs- ing programs. Similarly, Orlando’s (1961, 1972) theory was derived from the report of an early nationally funded research project designed to study nursing practice.

I attended the Nurse Educator Nursing Theory Conference in New York City in 1978, where the ma- jor theorists were brought together on the same stage for the first time. Most of them began their presenta- tions by stating that they were not theorists. Although complete understanding of the significance of these works for nursing was limited at the time, many in the audience seemed to be aware of the significance of the event. After the first few introductions, the audi- ence laughed at the theorists’ denial of being theorists and listened carefully as each theorist described the

theoretical work they had developed for curricula, research, or practice.