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4 UNIT I Evolution of Nursing Theories

developing graduate nursing programs (Alligood, in education, administration, and practice” (p. 4). An
2010a). In the mid-1970s, an evaluation of the first important precursor to the theory era was the gen-
25 years of the journal Nursing Research revealed that eral acceptance of nursing as a profession and an
nursing studies lacked conceptual connections and academic discipline in its own right.
theoretical frameworks, accentuating the need for The theory era was a natural outgrowth of the re-
conceptual and theoretical frameworks for develop- search and graduate education eras (Alligood, 2010a;
ment of specialized nursing knowledge (Batey, 1977). Im & Chang, 2012). The explosive proliferation of
Awareness of the need for concept and theory devel- nursing doctoral programs from the 1970s and
opment coincided with two other significant mile- nursing theory literature substantiated that nursing
stones in the evolution of nursing theory. The first doctorates should be in nursing (Nicoll, 1986, 1992,
milestone is the standardization of curricula for nurs- 1997; Reed, Shearer, & Nicoll, 2003; Reed & Shearer,
ing master’s education by the National League for 2009; 2012). As understanding of research and
Nursing accreditation criteria for baccalaureate and knowledge development increased, it became obvi-
higher-degree programs, and the second is the deci- ous that research without conceptual and theoretical
sion that doctoral education for nurses should be in frameworks produced isolated information. Rather,
nursing (Alligood, 2010a). there was an understanding that research and theory
The research era and the graduate education era together were required to produce nursing science
developed in tandem. Master’s degree programs in (Batey, 1977; Fawcett, 1978; Hardy, 1978). Doctoral
nursing emerged across the country to meet the pub- education in nursing began to flourish with the
lic need for nurses for specialized clinical nursing introduction of new programs and a strong emphasis
practice. Many of these graduate programs included on theory development and testing. The theory
a course that introduced the student to the research era accelerated as works began to be recognized as
process. Also during this era, nursing master’s pro- theory, having been developed as frameworks for
grams began to include courses in concept develop- curricula and advanced practice guides. In fact, it
ment and nursing models, introducing students to was at the Nurse Educator Conference in New York
early nursing theorists and knowledge development City in 1978 that theorists were recognized as nurs-
processes (Alligood, 2010a). Development of nursing ing theorists and their works as nursing conceptual
knowledge was a major force during this period. The models and theories (Fawcett, 1984; Fitzpatrick &
baccalaureate degree began to gain wider acceptance Whall, 1983).
as the first educational level for professional nursing, The 1980s was a period of major developments in
and nursing attained nationwide recognition and nursing theory that has been characterized as a tran-
acceptance as an academic discipline in higher edu- sition from the pre-paradigm to the paradigm period
cation. Nurse researchers worked to develop and (Fawcett, 1984; Hardy, 1978; Kuhn, 1970). The pre-
clarify a specialized body of nursing knowledge, with vailing nursing paradigms (models) provided per-
the goals of improving the quality of patient care, spectives for nursing practice, administration, educa-
providing a professional style of practice, and achiev- tion, research, and further theory development. In
ing recognition as a profession. There were debates the 1980s, Fawcett’s seminal proposal of four global
and discussions in the 1960s regarding the proper nursing concepts as a nursing metaparadigm served
direction and appropriate discipline for nursing as an organizing structure for existing nursing frame-
knowledge development. In the 1970s, nursing con- works and introduced a way of organizing individual
tinued to make the transition from vocation to pro- theoretical works in a meaningful structure (Fawcett,
fession as nurse leaders debated whether nursing 1978, 1984, 1993; Fitzpatrick & Whall, 1983). Clas-
should be other-discipline based or nursing based. sifying the nursing models as paradigms within a
History records the outcome, that nursing practice metaparadigm of the person, environment, health,
is to be based on nursing science (Alligood, 2010a; and nursing concepts systematically united the nurs-
Fawcett, 1978; Nicoll, 1986). It is as Meleis (2007) ing theoretical works for the discipline. This system
noted, “theory is not a luxury in the discipline of clarified and improved comprehension of knowledge
nursing . . . but an integral part of the nursing lexicon development by positioning the theorists’ works in a