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The nursing theory has been a dominant topic in the last 35 years and has stimulated remarkable development in the nursing practice. According to Raile Alligood (2017), the history of the nursing theory that shaped the development of knowledge started with Florence Nightingale (1859-1969), who visualized nurses a group of learned women at a period when they were not involved in public service. Nightingale's vision resulted in the establishment of a nursing school at St. Thomas' Hospital in London, introducing contemporary nursing. Her pioneering activities and literature about nursing guided the establishment of nursing colleges in the U.S. at the start of the twentieth century (Raile Alligood, 2017).
In the past century, a historical trend that have shaped the development of nursing knowledge has been a strong emphasis on practice. Raile Alligood (2017) indicates that throughout the century, nurses have developed nursing education through sequential historical eras.The first era was the curriculum era that covered what nurses should study in the practice. This era emphasized on the courses that should be taken by nursing students, intending to standardize the curriculum. This resulted in the development of a standardized curriculum in the mid-1930s (Raile Alligood, 2017). During this era, the idea of shifting nursing training from the hospital setting to colleges was embraced, and in the middle of the century, many states began implementing this idea. As nurses began attending colleges and universities to acquire nursing degrees, they also ventured into research, and therefore, the research era emerged. The research era emerged as nursing students embraced higher education and came to understand the role of the scientific age. Nurses started to engage in research, and research units were incorporated in nursing curricula (Raile Alligood, 2017).
The graduate education era closely followed the research era.Master's degree programs were introduced to fulfill the public need for nurses with expert skills. Raile Alligood (2017) further points out that this era also saw most master’s degrees in nursing begin to include the nursing theory that familiarized students with earlier nursing theorizers and the knowledge growth and development process. This resulted in the theorist era that was highly influenced by the previous development in the research era and graduate education period. With nurses exposed to research and the process of knowledge development, it became evident that research without theories resulted in isolated information, and it was a combination of research and theory that influenced the science of nursing (Raile Alligood, 2017). The beginning of the theory era resulted in the doctoral training flourishing, and more significance was placed on the growth of theories than its application in the practice of nursing. Nonetheless, the current phase of the theory era has resulted in theory-based nursing practice and continued development of theories (Raile Alligood, 2017).
Nursing theory has undergone each era, addressing the nursing knowledge in a distinctive manner that has contributed to the development of knowledge. In the last four decades, the development of theories has progressed rapidly, leading to the acknowledgement of nursing as an academic domain with a model of knowledge. Raile Alligood (2017) notes that in the 1950s, the nursing practice emerged as a science that was based on ideologies and principles learned through traineeship. The nursing practice continued to be regarded as an occupational tradition, rather than a profession and an academic discipline. The changeover from occupation to profession integrated all the periods of history as nurses researched a domain of applicable knowledge to support practice. However, in the mid-1970s, an assessment of nursing studies revealed that the practice required theoretical structures (Raile Alligood, 2017). Another need that was identified was the regularization of the programs for nursing master’s training and the introduction of doctoral education in nursing.
In the 1980s, significant progress in nursing theory were considered as a move from the pre-paradigm to the paradigm (models) age. Raile Alligood (2017) shows that these paradigms offered perspectives for the nursing practice, education, research, administration, and further expansion of theories. Nursing paradigms were classified as models within a metaparadigm of various conceptions such as person, environment, health and nursing, thereby uniting the theoretical works of nursing into a methodical view. Currently, the body of nursing science and research, practice, administration, and education continue to develop through nursing studies and research. Research papers, journals, newsletters, and books continue to be written by scholars associated with different nursing models and theories, describing each model and theory (Raile Alligood, 2017). In the new century, the era of theory continues to focus on using the nursing understanding to guide the critical thinking needed for expert practice. This has resulted in four theoretical works that include nursing theories, philosophies, conceptual models and grand theories, and middle-range nursing theories.
Nursing is both an art and science. As a science, the nursing practice utilizes theories where the nursing theory derives work from other areas of study and related to nursing previous nursing models and theories. For example, the Orlando theory provides a case where a particular style of communication is required within the nurse-patient relationship (Raile Alligood, 2017). Liberal arts also teach nurses how to think critically, analyze problems, and solve problems. The science also enables nurses to apply the knowledge of anatomy and physiology, sociology, and psychology to diagnose and treat patients. Nurses also base their practice on evidence-based research to make quality decisions. Lastly, the science part of the nursing practice enables them to serve patients, their families, and communities in diverse roles that include educators, researchers, administrators, and direct care providers in hospital settings.
Nursing as an art entails providing holistic and culturally congruent care, and while caring for the patients, the nurse should treat patients and their families with respect and dignity. Nursing as an art also necessitates creative approaches to providing since patients have diverse needs (Raile Alligood, 2017). Nurses develop trust and familiarity with patients that depend on them and it is through building relationships that they can provide holistic care. Additionally, nurses should understand the complexities of family dynamics, emotions of patients, and their families during illness (Raile Alligood, 2017). Therefore, nurses need to strike a balance between the science and art of the nursing practice.
Raile Alligood, M. (2017). Nursing theorists (9th ed.). Riverport Lane: Elsevier.