Evolution of Nursing

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INTRODUCTION
2. The Columbia School- The 1950s
Theory
- is important to both nursing as a discipline and as - operated from a biomedical model that focused

a profession primarily on what nurses do, their functional roles;

patient problems/needs to be the practice focus
Nursing Theories -Nursing practice was based on principles and
- guide the thought and action of nursing practice traditions passed on through apprenticeship
as well as they also guide the critical thinking education and common sense wisdom that came
required for professional practice with years of experience

Philosophy of Nursing Science Hildegard Peplau(1952)

- explores the meaning of truth, the meaning of - introduced her Theory of Interpersonal Relations
evidence, and the meaning of life through praxis that puts emphasis on the nurse-client relationship
as the foundation of nursing practice

Many nurses in the early eras rendered quality Virginia Henderson

care to patients. However, much of what was - conceptualized the nurse’s role as assisting sick or
known about nursing was not written down and healthy individuals to gain independence in
the effectiveness of the care they delivered was meeting 14 fundamental needs, thus her Nursing
not recorded. The advent of the twentieth
Need Theory was developed
century saw the development of a substantive
body of nursing knowledge to guide nursing
practice 3. The Yale School- The 1960s
- focus nurse-patient relationship
- nursing practice continued to reflect vocational
heritage more than professional vision
HISTORY OF NURSING THEORIES
- Influenced by the Columbia Teacher’s College
graduates who became faculty members there like
1. Florence Nightingale’s (1859/1992)
Virginia Henderson
- “Notes on Nursing: What It Is and What It Is Not”
- presents the 1st nursing theory as Ida Jean Orlando
“Environmental Theory “ that focuses on the - emphasized the reciprocal relationship between
environment for the benefit of the patient; it is the the patient and nurse and viewed the professional
act of utilizing the environment of the patient to function of nursing as finding out and meeting the
assist him in his recovery patient’s immediate need for help
- Nightingale expressed her firm conviction that
nursing knowledge was distinct from medical Faye Abdellah’s

knowledge - “Typology of 21 Nursing Problems” that shifted the

- She described a nurse’s proper function as putting focus of nursing from a disease-centred approach

the patient in the best condition for nature to act to a patient-centred one

upon him or her

View nursing as a process not an end in itself
Evolution of Nursing
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4. The 1970s 6. The Future (Meleis, 1992)

- Transition from vocation to profession mentioned the following:

-This progress in nursing theory is a most significant

- “Predicated on understanding the meanings of
aspect of scholarly evolution and the cornerstone of
the nursing discipline daily lived experiences as they are perceived by

the members or the participants of the science

The decade in which many nursing theories were
- Increased emphasis on the practice-orientation,
first presented like Rogers Introduction to the
1990s or actual rather than “ought-to-be” practice

- Nursing’s mission is to develop theories to

- In the 1990s, research studies that tested and empower nurses, the discipline and clients
expanded nursing theory were numerous like
Rosemarie Rizzo Parse’s changed the language of Significance for the Discipline and Profession
her theory from Man-Living-Health to the theory of
Human Becoming Discipline
– is specific to academia & refers to a branch of
-She explained that contemporary dictionary education, a department of learning, or a domain of
definitions of “man” tend to be gender-based, as knowledge
opposed to meaning mankind, theoretical basis of
nursing Profession
– refers to a specialized field of practice, which is
Jean Watson’s Nursing founded on the scientific structure of the science of
- The philosophy and science of caring highlighted knowledge of that discipline & the accompanying
the humanistic aspects of nursing as they intertwine practice abilities
with scientific knowledge and nursing practice
Significance of Theory for Nursing as a
5. The 1980s Discipline
- transition from the pre paradigm period to the ●​ The discipline is dependent upon a theory
paradigm period
●​ The theoretical works have taken nursing to
Dorothy Johnson a higher level
- Behavioural system Model for nursing and upheld ●​ Emphasis has shifted on what nurses know
the fostering of efficient and effective behavioural and how they use knowledge to guide their
functioning in the patient to prevent illness thinking and decision making
●​ Nursing as an academic discipline is
Betty Neuman dependent upon the existence of nursing
- System Model of nursing practice states that knowledge
many needs exist, and each may disrupt client ●​ This knowledge is transmitted to those
balance or stability entering the profession as a basis for their
- Stress reduction is the goal of the system model practice in the profession
of nursing practice
Evolution of Nursing
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●​ “By studying them and by practicing with ●​ Organize, examine and analyse patient’s
them, the members of their corresponding data
community learn their trade.” Kuhn
●​ Make decisions about effective and efficient
nursing interventions
●​ Make a specific, measurable, attainable,
Significance of Theory for Nursing as a
realistic and time-bounded plan of care
Profession
●​ Predict and evaluate outcomes of care

• ​ Utilizes in its practice a well-defined body of

specialized knowledge that is on the NURSING SCIENCE
intellectual level of higher learning.
- unique human science which focuses on
phenomena related to health
• ​ Constantly enlarges the body of knowledge it
- focuses on the quality of life for each person
uses and improves its techniques of education
- does not investigate health phenomena based
and service by the use of scientific method.
on causality
• ​ Entrusts the education of its practitioners to
institutions of higher learning. “Health as lived experience is investigated from
the point of view of healthcare consumers.”
• ​ Nursing as an academic discipline is ​ Dr. Teruko Takahashi-Japan
dependent upon the existence of nursing
knowledge.
History and Philosophy of Nursing Science
• ​ Applies its body of knowledge in practical
Rationalism
services that are vital to human and social
– makes use of reason gained thru expert study,
welfare.
tested theory and established facts to evidently

• ​ Functions autonomously in the formulation of prove something

professional policy and in the control of - Deductive type of reasoning is used

professional activity thereby.

Empiricism

• ​ Attracts individuals of intellectual and – makes use of objective and tangible data or

personal qualities who exalt service above those that are perceived by the senses to observe

personal gain and who recognize their chosen and collect data

occupation as a life work. -no knowledge that arises through reason alone
- empiricism credo is that where there is (or can
• ​ Strives to compensate its practitioners by be) no experience there is ( and can be ) no
providing freedom of action, opportunity for knowledge
continuous professional growth, and - inductive type of reasoning
economic security
Example: In nursing, the use of empiricism is highly
Nursing Theory and the Practising Nurse important in the assessment of patients all
throughout the entire nursing process.
Theory assists the practising nurse to:
Evolution of Nursing
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Early 20th Century Views - It was proposed by Barbara A. Carper, a professor

at the College of Nursing at Texas Woman’s
Experimentation University, in 1978
- step in the scientific method that helps people
decide between two or more competing - In 1995, Jill White identified another pattern of
explanations or hypothesis knowing which is socio-political

- use of experimentation to gain new knowledge as - In 2008, Chin and Kramer introduced the pattern
nurses strive to base their actions on evidence and of emancipatory knowing because of its link to
scientific data underlying critical social perspectives and its
interference as an outcome of nursing practice
Positivism
- positive knowledge is exclusively derived from
Fundamental Patterns of Knowing in Nursing
experience of natural phenomena and their
properties and relations; it encloses the use of both
Empirical – the scientific discipline of nursing
logical reasoning and empiricism in the delivery of
truth for the development of science Ethical – the moral directions of nursing

- true knowledge comes from studying observable Personal – method by which nurses approach their
traits and actions rather than through reasoning or clients
speculating
Aesthetics – deals with the emphatic aspect of
nursing
Example: A Christian absolutely certain there is God.
Empirical & objective data co-exist Socio-political /emancipatory– the praxis of
nursing
Emergent Views
Empirical Knowing
- evolution of nursing science was further studied
and tested that led to the contemporary • The principal form relating to factual and
descriptive knowing aimed at the expansion
practices in nursing
of abstract & theoretical explanations.

Nurses now have a vital role in the maintenance of • Focuses on evidence-based research for
health and survival of the sick and dying in effective and accurate nursing practice
collaboration with other health professionals.
• Emphasizes scientific research is important
Collaboration is the process of two or more people
to nursing knowledge
or organizations working together to complete a
task or achieve a goal. • First primary model of knowing (Kenney,
1996)
LESSON 2: FUNDAMENTAL PATTERNS OF
• It is information source or base of knowing
KNOWING IN NURSING
obtained from textbooks, lectures, journals
and online resources.
- In healthcare, the fundamental pattern of knowing
is a typology that attempts to classify the different • It is where most theory and research
sources from which knowledge and beliefs in development is concentrated and some
professional practice can be or have been derived
Evolution of Nursing
TFN| BSN1- D | S.Y. 2025-2026 (1st Term)

conceptual forms have better capacity to • Focuses on EMPATHY- the ability for
explain nursing phenomena than others sharing or vividly understanding
another’s feeling. This is the primary form
Examples: David, a nursing student answers a
question posed by the clinical instructor of aesthetic knowing.
based on what he learned from school.
• Includes nurse’s ability ways and manner
Elmer, a nurse researcher uses scientific method of rendering nursing care.
to produce desired study results
• Done by knowing the individual
Evidence-Based Practice (EBP) as part of distinctively.
Empirical Knowing
• Used in the process of giving appropriate
• ​ It uses a form of evidence in making clinical
nursing care through understanding the
judgment.
uniqueness of every patient, thus
• ​ Involves accurate and thoughtful decision emphasizing use of creative and
making about health care delivery system. practical styles of care..

• ​ Based on results of the most relevant and Examples: Nurse Xian uses layman terms in
supported evidences. explaining the needs of the patient with
right-sided heart failure.
• ​ Bridges the gap of nursing practice and
research. Nurse Ace shows compassion, mercy and
understanding towards patients, co-workers
Six Characteristics of Quality Health and supervisors.
Care that Reinforces Aspects of EBP
Ethical Knowing
​ C=client-centered
A=attuned with system policies and • ​ Requires knowledge of different philosophical
resources positions regarding what is good and right in
​ S=scientifically-based making moral actions and decisions
​ P=population outcome based particularly in the theoretical and clinical
​ I=individualized to client’s needs components of nursing.
​ D=developed thru quality and
improvement and bench marking • ​ Involves knowing the judgment of right and
wrong in relation to intentions, reasons and
Aesthetic Knowing attributes of individuals and situations.

• Related to understanding what is • ​ Deeply rooted in the concepts of human

significance to particular clients such as dignity, service and respect for life.
feelings, attitudes, points of view (Carper,
• ​ Lessening suffering, upholding and
1978).
preserving health is one of the key elements
• A manifestation of creative and expressive why nursing is a core service in society.
styles of the nurse.( Kenney, 1996)
Evolution of Nursing
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• ​ It includes all deliberate nursing actions self-awareness sessions before his

involving and under the jurisdiction of ethics psychiatric nursing rotation.
and professionalism (Kenney, 1996)
Socio-political/Emancipatory
• ​ Code of morals or code of ethics is the main
• ​ Nursing politics & policies, developed by
basis for ethical knowing.
means of paying attention to all relevant
Examples: Sir Karlo, a clinical instructor, voices in healthcare situations so to
reprimands a student who cheated on a quiz describe the social, cultural, and political
and explains the consequences. contexts of nurse-patient interactions
and of all healthcare settings
Nurse Hero explains the concepts behind
organ donation to a terminally-ill patient. • ​ The praxis of nursing- requires an
understanding of how to connect with
Personal Knowing
and motivate people where they are.

• Encompasses knowledge of the self in

• ​ Occurs on two levels-socio-political
relation to others and self.
contexts of the persons (nurse & patient)

• Involves entirely the Nurse-Patient & the socio political context of nursing as

Relationship. a practice profession including both

societies understanding of nursing and
• Focused on realizing, meeting and nursing’s understanding of society and its
defining the real, true self or politics.
“self-awareness”
Example: Nurse Leah, actively lobbied and
• Involves therapeutic use of self; the key fought for the Salary Grade 15 entry level for
in comprehending health. In terms of Nurse 1 position in government hospitals and
personal well-being got the approval of the Supreme Court.

• ​ The most difficult to master and to teach;

STRUCTURE OF NURSING KNOWLEDGE
it takes a lot of time to fully know the
nature of one self in relation to the whole Philosophy

world - next knowledge level after metaparadigm

- it specifies the definition of the metaparadigm
• ​ It stresses that human beings are not in a concepts in each of the conceptual models of
fixed state but are constantly engaged in nursing
a dynamic state of changes (Kenney, - it sets forth the meaning of phenomena through
1996) analysis, reasoning, and logical argument
- Ex: Nightingale’s Work
Examples: Red, a nursing student, strives to
promote a meaningful personal
Conceptual Models or framework
relationship with his elderly patient.
- representations of an idea or body of knowledge
Cyrus, a nursing student, undergoes based on their own understanding or perception of
psychological counseling and
Evolution of Nursing
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a person or researcher on a certain topic, Disease process -Stomach ulcer

phenomena or theory Clinical or environmental setting of nursing-
- They can be represented thru a diagram or in Health center
narrative form which shows how concepts are Client’s behavior- Guarding behavior at the pain
interrelated site
- It is also a paradigm that provides a broad frame Interventions-Care of the client in pain
of reference for systematic approaches to the
Practices- that are utilized in nursing theories and
phenomena with which the discipline is concerned metaparadigm

All natural events that the human senses can

perceive can be called a phenomenon

Theoretical models or frameworks

- are a highly established set of concepts that are Theory
testable
- an organized set of related statements that
Middle-range theories describes or explains phenomena in a systematic
- least abstract level of theoretical knowledge way
because they include details specific to nursing - a group of related concepts that propose actions
practice that guide practice

- includes information indicating the situation or -composed of Concepts, Propositions,

health condition, the patient population or age Assumptions, and Definitions intended to explain a
group, the location or area of practice, and the set of fact, event or phenomena
action of the nurse, or the intervention
Theory is T-H-E-O-R-Y
-They were also developed from the themes of data
in qualitative research • True possibly-not known or proven to be true
- Example: Nola J. Pender: The health Promotion
• Hypothetical sets of facts, principles or
Model.
circumstances

Grand Theories • Explains facts, events or phenomena

- theories because they do propose something that
• Organized set of related statements
is true or testable such as Roy’s theory of the person
• Rooted from the Greek word “theoria”- “looking
as an adaptive system derived from the Roy
at, viewing, beholding”
Adaptation Model
• Yes! it is followed as a basis of action
Phenomena
- subject matter of a discipline Concept

- sets of empirical data or experiences that can be - a mental idea of a phenomenon

physically observed or tangible - the building blocks of theories

Nursing Phenomena can be:

Evolution of Nursing
TFN| BSN1- D | S.Y. 2025-2026 (1st Term)

- can come from an empirical phenomena or any Definition-composed of various descriptions which
abstraction of how a person perceived an object convey a general meaning and reduces the
that is not physically present or observed vagueness in understanding a set of concepts
-enhances one’s capacity to understand
phenomena as it helps define the meaning of a How other authors define THEORY:

word
1. Chin and Kramer (1991)

Two types of concepts: – a creative and rigorous structuring of ideas that

projects a tentative, purposeful and systematic view
1. Abstract of phenomena.
– are indirectly observed or intangible; it is
independent of time and place. Examples: 2. Parker (2001)

love, care, freedom - organized, coherent set of concepts and their

relationship to each other that offers descriptions,
2. Concrete explanations and predictions about phenomena.
- is directly observed or tangible. Examples: nurse,
mother, pain 3. Potter (2004)
- set of concepts, definitions, relationships and
Conceptual Definitions
assumptions that project a systematic view of
- meaning of a word based on how a certain theory
phenomena.
or relevant literature perceives it to be
- Examples: roles/concepts of nurse, patient care, 4. Blackwell (2005)
and environment – a reasoned proposed explanation of an
- Comparable to definition from a literature such as occurrence, or of something that will occur or be
a dictionary, encyclopaedia, and journals. produced, for which absolute proof is lacking.

Operational Definitions 5. Delaune and Ladner (2006)

- meaning of a word based on the method of how it – a set of concepts and propositions that provide an
was measured or how the person came up with that early way to view phenomena.
perception.
6. Mosby (2006)
-Example: significance of pain perception and
–an abstract statement formulated to predict,
practiced nursing intervention.
explain or describe the relationships among
- Specifies exactly how the concept will be
concepts, constructs or events. It is tested by
determined and assessed; it also identifies
observation and research using factual data.
procedures and operations significant to determine
concepts
7. Kozier (2008)

Proposition - a statement of relationship between – is a supposition or system of ideas that is

concepts proposed to explain a given phenomenon

Assumption-statement that specifies the Characteristics of Theories

relationship of factual concepts/phenomena.
1. Can correlate concepts/generate a different way
of looking at a certain fact or phenomenon.
Evolution of Nursing
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-​ Theory must identify more than one concept explaining, or predicting events in clinical
and that the relationship between these practice.
concepts must be clear.
7. Consistent with other validated theories, laws
2. Logical in nature and principles but will open unanswered issues
that need to be tested.
-​ Interrelationships of concepts must be
sequential and consistently used within the -​ The logic of theories and their assumptions
theory. must be based on underlying laws,
-​ No contradictions between the definitions of previously validated knowledge and
concepts, their relationships within the theory humanitarian values that are generally
and the goals of theory. accepted as good and right

3. Simple but generally broad in nature.

-​ Theory defined as” tight, “parsimonious”.

-​ A theory of communication that can be
explained simply and generalized to all
person-to-person interactions.

4. Can be the source of hypotheses that can be

tested for it to be elaborated.

-​ Quantitative research tests hypotheses in

clinical practice and uses statistical analyses
to arrive findings.
-​ Qualitative research expands theory by using
a different research methodology that
focuses on the lived experiences of persons.

5. Contribute in enriching the general body of

knowledge.

-​ Theories contribute to the general knowledge

of the discipline of nursing.
-​ Validation of theories enhances the ability of
the nurse to describe, explain, predict, or
control nursing practice.

6. Can be used by practitioners to direct and

enhance their practice.

-​ Theories can be used to guide/improve

nursing practitioners by describing,
Evolution of Nursing
TFN| BSN1- D | S.Y. 2025-2026 (1st Term)