theories and new research methodologies and approaches continue to expand Carper’s

(1978) ways of knowing among nurse scientists. The use of nursing philosophies,

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

(Alligood, 2014, 2018; Fawcett, 2016; Smith, 2020). Practice in nursing today requires

knowledge of and use of the theoretical works of the discipline (Alligood, 2014, 2018;

Fawcett, 2016; Roy, 2018). Pickler (2018) stresses the importance of using theory and

being explicit about the theory one is using. Theory is relevant in the history of

nursing’s progress toward specialized nursing knowledge, and that knowledge

contributes to recognition and appreciation of the significance of nursing as a profession

and a discipline.

SIGNIFICANCE OF NURSING THEORY

At the beginning of the 20th century, nursing was not recognized as an academic

discipline or a profession, but the accomplishments of the past century have led to

recognition of nursing in both areas. The terms discipline and profession are interrelated,

and the meaning of each is important. An academic discipline is a branch of knowledge

or field of study taught and researched as a branch of higher learning. A profession

refers to an occupation with preparation in specific knowledge in higher learning and

the performance of a practice. It is important to note their differences and specific

meaning, as presented in Box 1.1. Nursing theory is significant for both the discipline

and the profession.

BOX 1.1

The Meaning of a Discipline Versus a Profession

• A discipline is specific to academia and refers to a branch of

education, a department of learning, or a domain of knowledge.

• A profession refers to a specialized field of practice, founded on the

theoretical structure of the science or knowledge of that discipline and

accompanying practice abilities.

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; Oxford American Dictionary (1980). New York: Avon Books.

Significance for the Discipline

When nurses entered baccalaureate and higher-degree programs in universities during

the last half of the 20th century, the goal of developing knowledge as a basis for nursing

practice began to be realized. University baccalaureate programs proliferated, master’s

programs in nursing were developed, and 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 science. They

addressed significant disciplinary questions about whether nursing was an applied

science or a basic science (Donaldson & Crowley, 1978; Johnson, 1959; Rogers, 1970;

Tobbell, 2018). 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 (Tobbell, 2018). In 1977 after the

journal Nursing Research had been published for 25 years, studies were reviewed

comprehensively and their strengths and weaknesses reported. Batey (1977) called

attention to the importance of nursing conceptualization in the research process and the

role of a conceptual framework in research design for the production of science. This

emphasis led to the theory development era and moved nursing forward to new

nursing knowledge for nursing practice. Soon 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 metaphor, now a classic publication, clarifying the interdependent

relationship of theory and research. Also at this time, nurse 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 for nursing practice or to structure curriculum content in nursing

programs. Orlando’s (1961, 1972) theory was derived from the report of an early

nationally funded research project that was designed to study nursing practice.
At the Nurse Educator Nursing Theory Conference in New York City in 1978, the

theorists were brought together on the same stage for the first time, although most of

them denied they were theorists, and understanding of the significance of the works for

nursing was limited at the time. Also noteworthy at this time, Donaldson and Crowley

(1978) presented the keynote address at the Western Commission of Higher Education

in Nursing Conference in 1977, just as the nursing doctoral program at the University of

Washington was about to open. They discussed the nature of nursing science and the

nature of knowledge needed for both the discipline and the profession. The published

version of their keynote address is a classic assignment for students to learn the

difference between the discipline and the profession of nursing. They called for both

basic and applied research, asserting that each type of knowledge was vital to nursing

as a discipline and as a profession. They argued that the discipline and the profession

are inextricably linked, but failure to separate them from each other anchors nursing in

a vocational rather than a professional view. The development of Doctor of Nursing

Practice (DNP) programs, not to be confused with nursing research Philosophy

Doctorates (PhD), is apropos to their point.

Soon nursing conceptual frameworks began to be used to organize curricula in

nursing programs and were recognized as models that address the values and concepts

of nursing. The creative conceptualization of a nursing metaparadigm (person,

environment, health, and nursing) as a structure of knowledge clarified the

relationships of the collective works of major nursing theorists as conceptual

frameworks and paradigms of nursing (Fawcett, 1984). This approach organized

nursing works into a system of theoretical knowledge, although developed by theorists

at different times and for different purposes in different parts of the country. Each

nursing conceptual model was classified on the basis of a set of analysis and evaluation

criteria (Fawcett, 1984, 1993). Recognition of the separate nursing works collectively

with a metaparadigm umbrella enhanced the recognition and understanding of nursing

theoretical works as a body of nursing knowledge. In short, the significance of theory

for nursing is that the discipline is dependent on theory for its continued existence—
that is, nursing can be a vocation, or nursing can be a discipline with a professional style

of knowledge-based practice. The theoretical works have taken nursing to higher levels

of education and practice as nurses moved from a functional focus, with emphasis on

what nurses do, to a patient focus, with emphasis on what nurses know about human

beings and their health. The theoretical structures provide nurses with a perspective of

the patient for professional practice. Professionals provide public service in a practice

focused on those whom they serve. The nursing process is useful in practice, but the

primary focus is the patient, or human being. Knowledge of persons, health, and

environment forms the basis for recognition of nursing as a discipline, and this

knowledge is taught to those who enter the profession. Every discipline or field of

knowledge includes theoretical knowledge. Therefore nursing as an academic discipline

depends on the existence of nursing knowledge (Alligood, 2011a; Grace et al., 2016;

McCrae, 2012). For those entering the profession, this knowledge is basic for their

practice. Kuhn (1970), a noted philosopher of science, stated, “The study of paradigms .

. . is what mainly prepares the student for membership in the particular scientific

community with which he [or she] will later practice” (p. 11). This is significant for all

nurses, but it is particularly important to those who are entering the profession because

“in the absence of a paradigm . . . all of the facts that could possibly pertain to the

development of a given science are likely to seem equally relevant” (Kuhn, 1970, p. 15).

Finally, with regard to the priority of paradigms, Kuhn (1970) states, “By studying