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CHAPTER 1 Introduction to Nursing Theory: Its History, Significance, and Analysis 7

a standardized curriculum was realized through theoretical work they had developed for curricula,
accreditation. Nursing had passed through eras of research, or practice.
gradual development, and nursing leaders offered Also noteworthy, Donaldson and Crowley (1978)
their perspectives on the development of nursing sci- presented the keynote address at the Western Com-
ence. They addressed significant disciplinary ques- mission of Higher Education in Nursing Conference
tions about whether nursing was an applied science in 1977, just as their nursing doctoral program was
or a basic science (Donaldson & Crowley, 1978; about to open. They reopened the discussion of the
Johnson, 1959; Rogers, 1970). History provides nature of nursing science and the nature of knowl-
evidence of the consensus that was reached, and edge needed for the discipline and the profession. The
nursing doctoral programs began to open to generate published version of their keynote address has be-
nursing knowledge. come classic for students to learn about nursing and
The 1970s was a significant period of development. recognize the difference between the discipline and
In 1977, after Nursing Research had been published for the profession. These speakers called for both basic
25 years, studies were reviewed comprehensively, and and applied research, asserting that knowledge was
strengths and weaknesses were reported in the journal vital to nursing as both a discipline and a profession.
that year. Batey (1977) called attention to the impor- They argued that the discipline and the profession are
tance of nursing conceptualization in the research inextricably linked, but failure to separate them from
process and the role of a conceptual framework in the each other anchors nursing in a vocational rather
design of research for the production of science. This than a professional view.
emphasis led the theory development era and moved Soon nursing conceptual frameworks began to be
nursing forward to new nursing knowledge for nursing used to organize curricula in nursing programs and
practice. Soon the nursing theoretical works began to were recognized as models that address the values
be recognized to address Batey’s call (Johnson, 1968, and concepts of nursing. The creative conceptualiza-
1974; King, 1971; Levine, 1969; Neuman, 1974; Orem, tion of a nursing metaparadigm (person, environ-
1971; Rogers, 1970; Roy, 1970). ment, health, and nursing) and a structure of knowl-
In 1978, Fawcett presented her double helix meta- edge clarified the related nature of the collective
phor, now a classic publication, on the interdependent works of major nursing theorists as conceptual frame-
relationship of theory and research. Also at this time, works and paradigms of nursing (Fawcett, 1984).
nursing scholars such as Henderson, Nightingale, This approach organized nursing works into a system
Orlando, Peplau, and Wiedenbach were recognized of theoretical knowledge, developed by theorists at
for the theoretical nature of their earlier writings. different times and in different parts of the country.
These early works were developed by educators as Each nursing conceptual model was classified on
frameworks to structure curriculum content in nurs- the basis of a set of analysis and evaluation criteria
ing programs. Similarly, Orlando’s (1961, 1972) theory (Fawcett, 1984; 1993). Recognition of the separate
was derived from the report of an early nationally nursing works collectively with a metaparadigm um-
funded research project designed to study nursing brella enhanced the recognition and understanding
practice. of nursing theoretical works as a body of nursing
I attended the Nurse Educator Nursing Theory knowledge. In short, the significance of theory for
Conference in New York City in 1978, where the ma- the discipline of nursing is that the discipline is
jor theorists were brought together on the same stage dependent upon theory for its continued existence,
for the first time. Most of them began their presenta- that is, we can be a vocation, or we can be a discipline
tions by stating that they were not theorists. Although with a professional style of theory-based practice.
complete understanding of the significance of these The theoretical works have taken nursing to higher
works for nursing was limited at the time, many in the levels of education and practice as nurses have moved
audience seemed to be aware of the significance of from the functional focus, or what nurses do, to a
the event. After the first few introductions, the audi- knowledge focus, or what nurses know and how they
ence laughed at the theorists’ denial of being theorists use what they know for thinking and decision mak-
and listened carefully as each theorist described the ing while concentrating on the patient.