were targeted toward moving nursing forward.

Fitzpatrick (1983) presented a historical

chronicle of 20th-century achievements that led to the professional status of nursing.

With recognition of nursing as a profession, the emphasis in this text is on the

relationship between nursing theoretical works and the status of nursing as a

profession. Although there are similarities and differences in sets of criteria used to

evaluate professions, it is important to note that they all call for a body of knowledge

that is foundational to the practice of the given profession.

As individual nurses grow in their professional status, the use of substantive

knowledge and theory-based evidence for decision-making is a quality that is

characteristic of their practice (Fawcett, 2016; Wood, 2020). This commitment to theorybased

evidence for practice is beneficial to patients in that it guides systematic,

knowledgeable care. It serves the profession as nurses are recognized for the

contributions they make to the health care of society. As noted previously in relation to

the discipline of nursing, the development of knowledge is a vital activity for nurse

scholars to pursue. It is important that nurses have continued recognition and respect

for their scholarly discipline and their contributions to the health of society.

Finally, the continued recognition of nursing theory as a tool for reasoning, critical

thinking, and decision-making is required for quality nursing practice. Professional

nursing practice requires a systematic approach that is focused on the patient, and the

theoretical works provide perspectives of the patient. The theoretical works presented

in this text illustrate those various perspectives. Philosophies of nursing, conceptual

models of nursing, nursing theories, and middle-range theories provide the nurse with

a view of the patient and a guide for data processing, evaluation of evidence, and

decisions regarding actions to be taken in practice (Alligood, 2014, 2018; Chinn &

Kramer, 2018; Fawcett, 2016; Wood, 2020). Globally, nurses have recognized the rich

heritage of the works of nursing theorists; that is, the philosophies, conceptual models,

theories, and middle-range theories of nursing have become numerous in the nursing

literature worldwide. Nursing literature, international contributors to this book, and the

publication of this text in multiple (at least 12) languages reflects the global use of
theory. The contributions of global theorists present nursing as a discipline and provide

a knowledge structure for further development. Theory-based research contributes to

evidence-based practice. That is, when nursing theory–based research is supported, it

becomes evidence. There is worldwide recognition of the rich diversity of nursing

values represented in nursing models and theories. Today we see added clarification of

the theoretical works in the nursing literature as more nurses learn and use theorybased

practice. The philosophies, models, theories, and middle-range theories are used

broadly in all areas—nursing education, practice, research, and administration. McCrae

(2012) argues that nursing theoretical knowledge takes on greater importance, because

evidence-based practice and multidisciplinary health care require nurses to articulate a

sound basis for their practice contributions to other professionals. Recognition of the

significance of professional nursing practice has been extremely evident during the

coronavirus disease 2019 (COVID-19) pandemic of 2020.

Nursing scholarship has greatly expanded the volume of literature around the

nursing philosophies, models, theories, and middle-range theories. In addition, the

philosophy of science for nursing knowledge development continues to expand with

new research approaches. More nurses are acquiring higher education and

understanding the value of nursing theory. The use of theory amplifies knowledge

development and enhances the quality of nursing practice (Alligood, 2011a, 2011b, 2014;

Chinn & Kramer, 2018; Fawcett, 2016; Grace et al., 2016; Im & Chang, 2012; McCrae,

2012; Wood, 2020).

SUMMARY

This chapter has introduced the vital nature of nursing theoretical knowledge from the

perspective of its history and significance. A focused history traced the progression

toward professional status based on the development of knowledge on which to base

nursing practice, verifying that nurses increase their professional power when using

systematic theoretical evidence for critical thinking and decision-making (McCrae,

2012). The significance of nursing theory is also verified as nurses use theory and

theory-based evidence to structure their practice and quality of care improves. Nurses
are able to sort patient data quickly, decide on appropriate nursing action, deliver care,

evaluate outcomes, and discuss the nature of their practice clearly with other health

professionals, which is vital for nurse participation in interdisciplinary care. Finally,

considering nursing practice in a theory context for education helps students develop

analytical skills and critical thinking ability as they clarify their values and assumptions.

Theory guides education, practice, research, and administration (Alligood, 2014; Chinn

& Kramer, 2018; Fawcett, 2016; Meleis, 2018).

The achievements of the profession over the past century were highly relevant to

nursing science development, but they did not come easily. History shows that many

nurses pioneered the cause of human health 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 (Kalisch & Kalisch, 2003; Meleis, 2018; Roy, 2018; Tobbell,

2018).

Since the publication of the first edition of Nursing Theorists and Their Work (Marriner,

1986), the volume of theoretical works has expanded considerably. There are nurses

who made significant contributions during the preparadigm period of nursing

knowledge development (Hardy, 1973, 1978). However, references to those early works

in the literature became increasingly limited despite their important contributions.

Therefore, in the sixth edition of this text (2006), a chapter of 10 selected exemplars of

that early development were recognized for their significant nursing knowledge

contributions. Chapter 2 of this text presents those selected exemplars (Box 1.3) of early

works and their updates to further explore the history and significance of nursing

theory in the discipline of nursing. Those interested in learning more about these early

nursing pioneers or any theorist whose work is included in this text are referred to the

original publications of the theorists. Nursing theoretical works represent the most

comprehensive presentation of systematic nursing knowledge and are therefore vital to

the future of both the discipline and the profession of nursing.

BOX 1.3

Early Theorists of Historical Significance