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Nursing Theory Application Brochure

In a simple and concise manner, describe the selected theory and how it could be useful and relevant to your chosen nursing environment. Please pay close attention to ensure that you attend to the following criteria:

1. Briefly describe the nursing environment that you wish to support (1 pt)

2. Describe the nursing theory/model that you plan to introduce (2 pts)

3. What are the strengths of that nursing theory? Why is it useful and relevant to that particular nursing unit, educational or research environment?

4. Use the six QSEN Competencies to explain how your chosen theory can be applied

a. Patient-centered care

b. Teamwork and collaboration

c. Evidenced-based practice (EBP)

d. Quality Improvements (QI)

e. Safety

f. Informatics

5. Select any two concerns below

Design a professional brochure that expresses clearly how your chosen theory could be applied to improve quality of any two of the following areas:

a. Patient care

b. Nursing education

c. Nursing research

d. Health disparities

6. Creativity: clarity and conciseness of the brochure

Please provide a complete and concise description of each of the areas being asked for. Vague write ups will not be assigned points.

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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

Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Copyright © 2010, 2006, 2002, 1998, 1994, 1989, 1986 by Mosby, Inc., an affiliate of Elsevier Inc.

All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher.

Notices

Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary.

Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such informa- tion or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility.

With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions.

To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein.

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

2013023220

Printed in the United States of America

Last digit is the print number: 9 8 7 6 5 4 3 2 1

Senior Content Strategist: Yvonne Alexopoulos Content Development Specialist: Danielle M. Frazier Publishing Services Manager: Deborah L. Vogel Project Manager: Pat Costigan Design Direction: Karen Pauls

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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vii

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

xii

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.

xiii

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

http: //www.healthsci.clayton.edu/eichelberger/nursing.htm
http: //www.sandiego.edu/academics/nursing/theory/
http: //www.fitne.net/
http: //www.healthsci.clayton.edu/eichelberger/nursing.htm
http: //www.sandiego.edu/academics/nursing/theory/
http: //www.fitne.net/
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

xv

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

UNIT 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

CH A P T ER 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).