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CHAPTER 1 Introduction to Nursing Theory: Its History, Significance, and Analysis 3

contributes to a deeper understanding of the work and individual hospital procedure manuals (Alligood,
(Chinn & Kramer, 2011). 2010a; Kalisch & Kalisch, 2003). Although some nurs-
ing leaders aspired for nursing to be recognized as a
profession and become an academic discipline, nursing
History of Nursing Theory practice continued to reflect its vocational heritage
The history of professional nursing began with Flor- more than a professional vision. The transition from
ence Nightingale. Nightingale envisioned nurses as vocation to profession included successive eras of his-
a body of educated women at a time when women tory as nurses began to develop a body of specialized
were neither educated nor employed in public service. knowledge on which to base nursing practice. Nurs-
Following her wartime service of organizing and car- ing had begun with a strong emphasis on practice,
ing for the wounded in Scutari during the Crimean and nurses worked throughout the century toward
War, Nightingale’s vision and establishment of a School the development of nursing as a profession. Progress
of Nursing at St. Thomas’ Hospital in London marked toward the goal of developing a specialized basis for
the birth of modern nursing. Nightingale’s pioneering nursing practice has been viewed from the perspec-
activities in nursing practice and education and her tive of historical eras recognizing the thrust toward
subsequent writings became a guide for establishing professional development within each era (Alligood,
nursing schools and hospitals in the United States at 2010a; Alligood & Tomey, 1997).
the beginning of the twentieth century (Kalisch & The curriculum era addressed the question of
Kalisch, 2003; Nightingale, 1859/1969). what content nurses should study to learn how to be
Nightingale’s (1859/1969) vision of nursing has a nurse. During this era, the emphasis was on what
been practiced for more than a century, and theory courses nursing students should take, with the goal
development in nursing has evolved rapidly over the of arriving at a standardized curriculum (Alligood,
past 6 decades, leading to the recognition of nursing 2010a). By the mid-1930s, a standardized curriculum
as an academic discipline with a specialized body had been published and adopted by many diploma
of knowledge (Alligood, 2010a, 2010b; Alligood & programs. However, the idea of moving nursing edu-
Tomey, 2010; Bixler & Bixler, 1959; Chinn & Kramer, cation from hospital-based diploma programs into
2011; Fawcett, 2005; Im & Chang, 2012; Walker & colleges and universities also emerged during this
Avant, 2011). It was during the mid-1800s that Night- era (Judd, Sitzman & Davis, 2010). In spite of this
ingale recognized the unique focus of nursing and early idea for nursing education, it was the middle of
declared nursing knowledge as distinct from medical the century before many states acted upon this goal,
knowledge. She described a nurse’s proper function and during the second half of the twentieth century,
as putting the patient in the best condition for nature diploma programs began closing and significant
(God) to act upon him or her. She set forth the follow- numbers of nursing education programs opened in
ing: that care of the sick is based on knowledge of colleges and universities (Judd, Sitzman, & Davis,
persons and their surroundings—a different knowl- 2010; Kalisch & Kalisch, 2003). The curriculum era
edge base than that used by physicians in their prac- emphasized course selection and content for nursing
tice (Nightingale, 1859/1969). Despite this early edict programs and gave way to the research era, which
from Nightingale in the 1850s, it was 100 years later, focused on the research process and the long-range
during the 1950s, before the nursing profession began goal of acquiring substantive knowledge to guide
to engage in serious discussion of the need to develop nursing practice.
nursing knowledge apart from medical knowledge to As nurses increasingly sought degrees in higher
guide nursing practice. This beginning led to aware- education, the research emphasis era began to emerge.
ness of the need to develop nursing theory (Alligood, This era began during the mid-century as more nurse
2010a; Alligood, 2004; Chinn & Kramer, 2011; Meleis, leaders embraced higher education and arrived at a
2007; Walker & Avant, 2011). Until the emergence of common understanding of the scientific age—that
nursing as a science in the 1950s, nursing practice was research was the path to new nursing knowledge.
based on principles and traditions that were handed Nurses began to participate in research, and research
down through an apprenticeship model of education courses were included in the nursing curricula of early