Chapter 1 Intro to Nursing Theory: Its History, Significance, and Analysis History - transition of nursing from vocation profession

ion - nursing as an academic discipline and a profession, linked in the theory era Significance - the history of nursing provides an outline for understanding the important and significance for professional practice during the theory era Analysis - the works of theories and their role in knowledge development play a crucial and essential role for acquiring knowledge, like any other science. History Florence Nightingale - envisioned nurses that encompasses educated women (at the time, women were uneducated and unemployed). - she believed that nursing knowledge is distinct from medical knowledge. Caring for the sick is based on knowledge of the person and their surrounding (treating the patient rather than disease). - established a school of nursing in London after her service during the Crimean War, marked the birth of modern nursing. - started off with a strong emphasis on practice but slowly leaned towards the development of nursing as a profession Curriculum era (course selection and content) - addressed the question of what nurses should study to become a nurse - what courses students should take and with the goal of having a standardized curriculum - nursing education moved from a hospital-based diploma program college/university Research Era - nurses started to search for higher education in the nursing field during scientific age, in order to develop new knowledge with research. More nurses began to participate in research and courses that focused on research were included in the curricula in graduate programs - M.D. programs emerged where specializing in certain aspects of nursing were developed to meet certain public needs. Some courses also included concept development or nursing models that introduced students to early nursing theorists. Theory Era - with more understanding of research and knowledge development increasing, the need for theory was essential because it goes hand in hand with practice. With theory comes the ability to determine certain contexts that are necessary for evidence to be collected, analyzed, and put into practice. - research and theory Nursing Science - PhD education in nursing flourished in the theory era with an emphasis on developing theories.

 Theory Utilization Era - emphasis on: a) middle range theory (MRT) for theory-based nursing practice b) theory development - Nursing practice needed to be based on nursing science, not from other disciplines - vocation profession Paradigms - models provided perspectives for: a) nursing practice b) administration c) education d) research e) theory development Fawcetts metaparadigm - he introduced a way of grouping individual theories that were once viewed as separate - presented a nursing metaparadigm, that describes 4 nursing concepts (PHEN) that served as a framework to organize its structure: 1) person 2) health 3) environment 4) nursing - many of the first theories comprised of individual efforts and works that were later published by nurse leaders. Later on, these published works came to be viewed collectively within a structure of knowledge. Nursing Theory Era - the development of theory is a product of scholarships and growth among nurse leaders, administrators, practitioners that sought higher education. These people knew that there were limitations in describing or predicting nursing outcomes from other disciplines. - there was a need for a scientific basis for nursing curricula, practice, management and research. By developing a theory to convey an organized structure scientifically, there was a convergence of ideas that resulted in the nursing theory era. Theory Utilization Era - this is the era where the emphasis started to shift towards applying theories in nursing practice, education, administration, and research. - much emphasis is placed on developing and using nursing theory to produce evidence for professional practice. In order to prepare for practice in the profession of nursing, we must acquire knowledge of theoretical works [Box 1-1] of the discipline.

[Box 1-1] Types of Nursing Theoretical Works Philosophies -the meaning of nursing through: a) analysis b) reasoning c) logical presentation -many works before the nursing era, provided a direction for knowledge development of the field. ex: Nightingale Conceptual Models -comprises nursing works by theorists -defines metaparadigm to explain concepts such as: a) person b) health c) environment d) nursing -models propose a direction or an action that is testable. -represents ways of thinking about a problem or explaining how complex things work the way they do -models may draw on many theories to help us understand a particular problem in a certain setting or context Nursing Theories -derived from nursing philosophy, conceptual models, and other disciplines. -some theories are specific to a particular aspect or setting MRT -specific focus and precise, answering specific nursing practice questions ex: age, family situation, action of nurses -address situations within the perspective of the model/theory they are derived from ex: health promotion, acute pain management, conceptual model of nursing, nurse-expressed empathy

Significance Nursing as a Discipline -specific to academics and includes a body of knowledge, practice, and a system of rules. - focuses on research and education, while adding a component of clinical practice as an art the use of knowledge in service of others as a science a body of knowledge based on scientific research and analysis - BScN, M.D. programs emerged with a standardized curriculum through eras of gradual development. - nursing research published; importance in conceptualizing nursing with a framework that eventually led nursing into the theory development era. At the same time, nursing philosophers started to get recognized for their contributions of early theoretical writings - early works of philosophers (ex: nightingale) were published by educators in order to develop a framework to structure the nursing curriculum and guide the programs. - Donaldson and Crowley (1978) presented a keynote address at a conference as their PhD program was about to open. They discussed that the nature of knowledge was crucial for the discipline and profession. Basic and applied research were needed, while stating that discipline and profession were linked. - theoretical works have taken nursing to higher levels of education and practice (vocation profession), so that nurses can critically think and use their knowledge to guide their decisions while concentrating on the patient. Conceptualizing frameworks of metaparadigms clarified and organized theoretical works into a system that enhanced the understanding of separate nursing works. Nursing as a Profession -the field of practice based upon theories and structures of the science or knowledge of that discipline -it is the application of knowledge -theory is also vital to the practice of professional nursing. -