write on Benner’s professional advancement theory/model (also known as Benner’s novice to expert theory / model).  Why did you choose the theory
Rough Draft Exemplar Paper
Jane Doe
Care Hope College
NUR315: Nursing Theory
Dr. Edward Kyle
Rough Draft Exemplar Paper
Articulate your purpose/point of paper: pull the readers in – make them interested in reading your paper, state what the purpose of your paper is – what are you trying to accomplish.
Overview of Nursing Theory
For your paper, specify selected theory in your title, i.e., “Overview of Watson’s Caring Theory. Provide readers with basic information and concepts related to your selected theory [be sure to include pertinent primary references to the theory so that the reader may access this information for further exploration]. This is not a “term” paper or “critique” of the selected theory – but you need to provide enough information for readers so that they can clearly understand the application and “fit” of the selected nursing theory to your exemplar/story.
Exemplar Encounter: My Encounter with Mr. Smith
Adapt title/heading as you see fit for your exemplar/story. This section of the paper includes a verbatim [narrative] report of your patient/nurse experience that will then be reflected on when you discuss how this particular nursing practice experience fits with your selected theory. For example, one student wrote an exemplar paper about a patient/nurse encounter that clearly involved the major concepts and element of Orem’s Self Care theory – after sharing her story, the student was able to discuss how Orem’s theory applied to how she cared for her pre-op patient.
Discuss Application of Theory
Highlight aspects of your “story”; explain how story/experience fits with theory – makes sense, etc. Paraphrasing aspects of your story – or the inclusion of direct quotes from the above section help to validate how your exemplar ties into the theory.
This section includes the “take away” from your paper. What can readers conclude from your paper, your exemplar experience, i.e., your exemplar promotes use of theory – reinforces how your selected theory is practical, useful, facilitates improved patient outcomes, etc.
Grammar, proper sentence structure, clarity of writing, flow of writing, adherence to course format for paper and selected journal, appropriate citation of references [use format required by journal].
Cribs, N. (2009). Nursing theory and theorists. Retrieved from http://nursingcrib.com/nursing-theory-theorists/
McEwen, M., & Wills, E. (2011). Theoretical basis for nursing, (3 ed.). Philadelphia, PA: Lippincott, Williams, & Wilkins.
University of San Diego. (2009). Nursing theory page. Retrieved from http://www.sandiego.edu/academics/nursing/theory/
Nursing Theorists
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Nursing Theorists
Martha Raile Alligood, PhD, RN, ANEF
Professor Emeritus
College of Nursing
East Carolina University
Greenville, North Carolina
3251 Riverport Lane
St. Louis, Missouri 63043
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material herein.
Library of Congress Cataloging-in-Publication Data
Nursing theorists and their work / [edited by] Martha Raile Alligood. — Eighth edition.
p. ; cm.
Includes biographical references and index.
ISBN 978-0-323-09194-7 9pbk. ; alk. Paper)
I. Alligood, Martha Raile, editor of compilation.
[DNLM: 1. Nursing Theory. 2. Models, Nursing. 3. Nurses—Biography. Philosophy, Nursing. WY 86]
Printed in the United States of America
Last digit is the print number: 9 8 7 6 5 4 3 2 1
Senior Content Strategist: Yvonne Alexopoulos
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Design Direction: Karen Pauls
Dedicated to the memory of my mother:
Winifred Havener Raile, RN
Class of 1936,
Good Samaritan School of Nursing,
Zanesville, Ohio
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Herdis Alvsvåg, RN, Cand Polit
Associate Professor
Department of Education and Health Promotion
University of Bergen
Bergen, Norway;
Associate Professor II
Bergen Deaconess University College
Bergen, Norway
Donald E. Bailey, Jr., PhD, RN
Associate Professor
School of Nursing
Duke University
Durham, North Carolina
Barbara Banfield, RN, PhD
Farmington Hills, Michigan
Violeta A. Berbiglia, EdD, MSN, RN
Associate Professor, Retired
The University of Texas Health Science Center
at San Antonio School of Nursing
San Antonio, Texas
Debra A. Bournes, RN, PhD
Director of Nursing
New Knowledge and Innovation
University Health Network
Toronto, Canada
Nancy Brookes, PhD, RN, BC, MSc (A),
Nurse Scholar and Adjunct Professor
Royal Ottawa Health Care Group
Royal Ottawa Mental Health Centre
University of Ottawa Faculty of Health Sciences
Ottawa, Ontario, Canada
Janet Witucki Brown, PhD, RN, CNE
Associate Professor
College of Nursing
University of Tennessee
Knoxville, Tennessee
Karen A. Brykczynski, PhD, RN, FNP-BC,
School of Nursing at Galveston
The University of Texas Medical Branch
Galveston, Texas
Sherrilyn Coffman, PhD, RN
Professor and Assistant Dean
School of Nursing
Nevada State College
Henderson, Nevada
Doris Dickerson Coward, RN, PhD
Associate Professor, Retired
School of Nursing
The University of Texas at Austin
Austin, Texas
Thérèse Dowd, PhD, RN, HTCP
Associate Professor Emeritus
College of Nursing
The University of Akron
Akron, Ohio
Nellie S. Droes, DNSc, RN
Associate Professor, Emerita
College of Nursing
East Carolina University
Greenville, North Carolina
Margaret E. Erickson, PhD, RN, CNS, AHN-BC
Executive Director
American Holistic Nurses’ Certification Corporation
Cedar Park, Texas
Mary E. Gunther, RN, MSN, PhD
Associate Professor
College of Nursing
University of Tennessee
Knoxville, Tennessee
Dana M. Hansen, RN, MSN, PhD
Assistant Professor
College of Nursing
Kent State University
Kent, Ohio
Sonya R. Hardin, PhD, RN, CCRN, NP-C
College of Nursing
East Carolina University
Greenville, North Carolina
Robin Harris, PhD, ANP-BC, ACNS-BC
Nurse Practitioner
Wellmont CVA Heart Institute
Kingsport, Tennessee
Patricia A. Higgins, PhD, RN
Assistant Professor
Frances Payne Bolton School of Nursing
Case Western Reserve University
Cleveland, Ohio
Bonnie Holaday, DNS, RN, FAAN
Professor and Director, Graduate Studies
School of Nursing and Institute on Family and
Neighborhood Life
Clemson University
Clemson, South Carolina
Eun-Ok Im, PhD, MPH, RN, CNS, FAAN
Professor and Marjorie O. Rendell Endowed
School of Nursing
The University of Pennsylvania
Philadelphia, Pennsylvania
D. Elizabeth Jesse, PhD, RN, CNM
Associate Professor
College of Nursing
East Carolina University
Greenville, North Carolina
Lisa Kitko, PhD, RN, CCRN
Assistant Professor
School of Nursing
The Pennsylvania State University
University Park, Pennsylvania
Theresa Gunter Lawson, PhD, APRN, FNP-BC
Assistant Professor
Department of Nursing
Lander University
Greenwood, South Carolina
Unni Å. Lindström, PhD, RN
Department of Caring Science
Faculty of Social and Caring Sciences
Åbo Academy University
Vasa, Finland
M. Katherine Maeve, PhD, RN
Nurse Researcher
Charlie Norwood VAMC
Augusta, Georgia
Marilyn R. McFarland, PhD, RN, FNP, BC, CTN
Associate Professor of Nursing and Family Nurse
Urban Health and Wellness Center
University of Michigan
Flint, Michigan
Gwen McGhan, PhD(c), RN
Jonas/Hartford Doctoral Scholar
School of Nursing
The Pennsylvania State University
University Park, Pennsylvania
Molly Meighan, RNC, PhD
Professor Emerita
Division of Nursing
Carson-Newman College
Jefferson City, Tennessee
Contributors ix
Patricia R. Messmer, PhD, RN-BC, FAAN
Patient Care Services Research
Children’s Mercy Hospital and Clinics
Kansas City, Missouri
Gail J. Mitchell, PhD, RN, MScN, BScN
School of Nursing
York-UHN Nursing Academy
York University
Toronto, Ontario, Canada
Lisbet Lindholm Nyström, PhD, RN
Associate Professor
Department of Caring Science
Faculty of Social and Caring Sciences
Åbo Academy University
Vasa, Finland
Janice Penrod, PhD, RN, FGSA, FAAN
Director, Center for Nursing Research
Associate Professor
School of Nursing
The Pennsylvania State University
University Park, Pennsylvania
Susan A. Pfettscher, DNSc, RN
Bakersfield, California
Kenneth D. Phillips, PhD, RN
Professor and Associate Dean for Research and
College of Nursing
The University of Tennessee
Knoxville, Tennessee
Marie E. Pokorny, PhD, RN
Director of the PhD Program
College of Nursing
East Carolina University
Greenville, North Carolina
Marguerite J. Purnell, PhD, RN, AHN-BC
Assistant Professor
Christine E. Lynn College of Nursing
Florida Atlantic University
Boca Raton, Florida
Teresa J. Sakraida, PhD, RN
Assistant Professor
College of Nursing
University of Colorado, Denver
Aurora, Colorado
Karen Moore Schaefer, PhD, RN
Associate Chair and Associate Professor, Retired
Department of Nursing
College of Health Professions
Temple University
Philadelphia, Pennsylvania
Ann M. Schreier, PhD, RN
Associate Professor
College of Nursing
East Carolina University
Greenville, North Carolina
Carrie J. Scotto, PhD, RN
Associate Professor
College of Nursing
University of Akron
Akron, Ohio
Christina L. Sieloff, PhD, RN, NE, BC
Associate Professor
College of Nursing
Montana State University
Billings, Montana
Janet L. Stewart, PhD, RN
Assistant Professor
Department of Health Promotion and Development
School of Nursing
University of Pittsburgh
Pittsburgh, Pennsylvania
Danuta M. Wojnar, PhD, RN, MEd, IBCLC
Assistant Professor
College of Nursing
Seattle University
Seattle, Washington
Joan E. Zetterlund, PhD, RN
Professor Emerita of Nursing
School of Nursing
North Park University
Chicago, Illinois
Jean Logan, RN, PhD
Grand View University
Des Moines, Iowa
Karen Pennington, PhD, RN
Associate Professor
Regis University
Denver, Colorado
Nancy Stahl, RN, MSN, CNE
Associate Professor
BSN Coordinator
University of North Georgia
Dahlonega, Georgia
About the Editor
Martha Raile Alligood is professor emeritus at East Carolina University College of Nursing in Greenville,
North Carolina, where she was Director of the Nursing PhD program. A graduate of Good Samaritan School of
Nursing, she also holds a bachelor of sacred literature (BSL) from Johnson University, a BSN from University of
Virginia, an MS from The Ohio State University, and a PhD from New York University.
Her career in nursing education began in Zimbabwe (formerly Rhodesia) in Africa and has included graduate
appointments at the University of Florida, University of South Carolina, and University of Tennessee. Among
her professional memberships are Epsilon and Beta Nu Chapters of Sigma Theta Tau International (STTI),
Southern Nursing Research Society (SNRS), North Carolina Nurses Association/American Nurses Association
(NCNA/ANA), and Society of Rogerian Scholars (SRS).
A recipient of numerous awards and honors, she is a Fellow of the National League for Nursing (NLN) Acad-
emy of Nursing Education, received the SNRS Leadership in Research Award, and was honored with the East
Carolina University Chancellors’s Women of Distinction Award. A member of the Board of Trustees at Johnson
University, Dr. Alligood chairs the Academic Affairs Committee.
She served as contributing editor for the Theoretical Concerns column in Nursing Science Quarterly, Vol. 24,
2011, and is author/editor of Nursing Theory: Utilization & Application, fifth edition, as well as this eighth edition
of Nursing Theorists and Their Work.
This book is a tribute to nursing theorists and a classic in theoretical nursing literature. It presents many major thinkers in nursing, reviews their important knowledge-building ideas, lists their publications, and points the reader to those using the works and writing about them in their own theoretical publications.
Unit I introduces the text with a brief history of nursing knowledge development and its significance to the
discipline and practice of the profession in Chapter 1. Other chapters in Unit I discuss the history, philosophy
of science and the framework for analysis used throughout the text, logical reasoning and theory development
processes, and the structure of knowledge and types of knowledge within that structure. Ten works from earlier
editions of Nursing Theorists and Their Work are introduced and discussed briefly as nursing theorists of
historical significance in Chapter 5. They are Peplau; Henderson; Abdellah; Wiedenbach; Hall; Travelbee;
Barnard; Adam; Roper, Logan, Tierney, and Orlando.
In Unit II, the philosophies of Nightingale, Watson, Ray, Benner, Martinsen, and Eriksson are presented.
Unit III includes nursing models by Levine, Rogers, Orem, King, Neuman, Roy, and Johnson. The work of
Boykin and Schoenhofer begins Unit IV on nursing theory, followed by the works of Meleis; Pender; Leininger;
Newman; Parse; Erickson, Tomlin, and Swain; and the Husteds. Unit V presents middle range theoretical works
of Mercer; Mishel; Reed; Wiener and Dodd; Eakes, Burke, and Hainsworth; Barker; Kolcaba; Beck; Swanson;
Ruland and Moore. Unit VI addresses the state of the art and science of nursing theory from three perspectives:
the philosophy of nursing science, the expansion of theory development, and the global nature and expanding
use of nursing theoretical works.
The works of nurse theorists from around the world are featured in this text, including works by international
theorists that have been translated into English. Nursing Theorists and Their Work has also been translated into
numerous languages for nursing faculty and students in other parts of the world as well as nurses in practice.
Nurses and students at all stages of their education are interested in learning about nursing theory and
the use of nurse theorist works from around the world. Those who are just beginning their nursing education,
such as associate degree and baccalaureate students, will be interested in the concepts, definitions, and theoreti-
cal assertions. Graduate students, at the masters and doctoral levels, will be more interested in the logical form,
acceptance by the nursing community, the theoretical sources for theory development, and the use of empirical
data. The references and extensive bibliographies are particularly useful to graduate students for locating
primary and secondary sources that augment the websites specific to the theorist. The following comprehensive
websites are excellent resources with information about theory resources and links to the individual theorists
featured in this book:
• Nursing Theory link page, Clayton College and State University, Department of Nursing: http: //www.
• Nursing Theory page, Hahn School of Nursing and Health Science, University of San Diego: http: //www.
• A comprehensive collection of nursing theory media, The Nurse Theorists: Portraits of Excellence, Vol. I and
Vol. II and Nurse Theorists: Excellence in Action: http: //www.fitne.net/
The works of the theorists presented in this text have stimulated phenomenal growth in nursing literature and
enriched the professional lives of nurses around the world by guiding nursing research, education, administra-
tion, and practice. The professional growth continues to multiply as we analyze and synthesize these works,
http: //www.healthsci.clayton.edu/eichelberger/nursing.htm
http: //www.sandiego.edu/academics/nursing/theory/
http: //www.fitne.net/
http: //www.healthsci.clayton.edu/eichelberger/nursing.htm
http: //www.sandiego.edu/academics/nursing/theory/
http: //www.fitne.net/
generate new ideas, and develop new theory and applications for education in the discipline and quality care in
practice by nurses.
The work of each theorist is presented with a framework using the following headings to facilitate uniformity
and comparison among the theorists and their works:
• Credentials and background
• Theoretical sources for theory development
• Use of empirical data
• Major concepts and definitions
• Major assumptions
• Theoretical assertions
• Logical form
• Acceptance by the nursing community
• Further development
• Critique of the work
• Summary
• Case study based on the work
• Critical thinking activities
• Points for further study
• References and bibliographies
I am very thankful to the theorists who critiqued the original and many subsequent chapters about themselves
to keep the content current and accurate. The work of Paterson and Zderad was omitted at their request.
I am very grateful to those who have contributed or worked behind the scenes with previous editions to
develop this text over the years. In the third edition, Martha Raile Alligood joined Ann Marriner Tomey, to
reorder the chapters, serve as a contributing author, and edit for consistency with the new organization of the
text. Subsequently Dr. Tomey recommended Dr. Alligood to Mosby-Elsevier to design and coedit a practice
focused text, Nursing Theory: Utilization and Application and based on Alligood’s expertise in nursing theory,
invited her to become coeditor and contributing author to future editions of this text, Nursing Theorists and Their
Work. I want to recognize and thank Ann Marriner Tomey for her vision to develop the first six editions of this
book. Her mentorship, wisdom, and collegial friendship have been special to me in my professional career. Most
of all, she is to be commended for her dedication to this text that continues to make an important and valuable
contribution to the discipline and the profession of nursing. I wish Ann well in her retirement.
Finally, I would like to thank the publishers at Mosby-Elsevier for their guidance and assistance through
the years to bring this text to this eighth edition. The external reviews requested by Mosby-Elsevier editors
have contributed to the successful development of each new edition. The chapter authors who over the years
have contributed their expert knowledge of the theorists and their work continue to make a most valuable
Martha Raile Alligood
UNIT I Evolution of Nursing Theories
1 Introduction to Nursing Theory: Its History, Significance, and Analysis, 2
Martha Raile Alligood
2 History and Philosophy of Science, 14
Sonya R. Hardin
3 Theory Development Process, 23
Sonya R. Hardin
4 The Structure of Specialized Nursing Knowledge, 38
Martha Raile Alligood
5 Nursing Theorists of Historical Significance, 42
Marie E. Pokorny
Hildegard E. Peplau
Virginia Henderson
Faye Glenn Abdellah
Ernestine Wiedenbach
Lydia Hall
Joyce Travelbee
Kathryn E. Barnard
Evelyn Adam
Nancy Roper, Winifred W. Logan, and Alison J. Tierney
Ida Jean (Orlando) Pelletier
UNIT II Nursing Philosophies
6 Florence Nightingale: Modern Nursing, 60
Susan A. Pfettscher
7 Jean Watson: Watson’s Philosophy and Theory of Transpersonal Caring, 79
D. Elizabeth Jesse and Martha R. Alligood
8 Marilyn Anne Ray: Theory of Bureaucratic Caring, 98
Sherrilyn Coffman
9 Patricia Benner: Caring, Clinical Wisdom, and Ethics in Nursing Practice, 120
Karen A. Brykczynski
10 Kari Martinsen: Philosophy of Caring, 147
Herdis Alvsvåg
11 Katie Eriksson: Theory of Caritative Caring, 171
Unni Å. Lindström, Lisbet Lindholm Nyström, and Joan E. Zetterlund
UNIT III Nursing Conceptual Models
12 Myra Estrin Levine: The Conservation Model, 204
Karen Moore Schaefer
13 Martha E. Rogers: Unitary Human Beings, 220
Mary E. Gunther
14 Dorothea E. Orem: Self-Care Deficit Theory of Nursing, 240
Violeta A. Berbiglia and Barbara Banfield
15 Imogene M. King: Conceptual System and Middle-Range Theory of Goal Attainment, 258
Christina L. Sieloff and Patricia R. Messmer
16 Betty Neuman: Systems Model, 281
Theresa G. Lawson
17 Sister Callista Roy: Adaptation Model, 303
Kenneth D. Phillips and Robin Harris
18 Dorothy E. Johnson: Behavioral System Model, 332
Bonnie Holaday
UNIT IV Nursing Theories
19 Anne Boykin and Savina O. Schoenhofer: The Theory of Nursing as Caring: A Model for
Transforming Practice, 358
Marguerite J. Purnell
20 Afaf Ibrahim Meleis: Transitions Theory, 378
Eun-Ok Im
21 Nola J. Pender: Health Promotion Model, 396
Teresa J. Sakraida
22 Madeleine M. Leininger: Culture Care Theory of Diversity and Universality, 417
Marilyn R. McFarland
23 Margaret A. Newman: Health as Expanding Consciousness, 442
Janet Witucki Brown and Martha Raile Alligood
24 Rosemarie Rizzo Parse: Humanbecoming, 464
Debra A. Bournes and Gail J. Mitchell
25 Helen C. Erickson, Evelyn M. Tomlin, Mary Ann P. Swain:
Modeling and Role-Modeling, 496
Margaret E. Erickson
26 Gladys L. Husted and James H. Husted: Symphonological Bioethical Theory, 520
Carrie Scotto
UNIT V Middle Range Nursing Theories
27 Ramona T. Mercer: Maternal Role Attainment—Becoming a Mother, 538
Molly Meighan
28 Merle H. Mishel: Uncertainty in Illness Theory, 555
Donald E. Bailey, Jr. and Janet L. Stewart
Contents xvii
29 Pamela G. Reed: Self-Transcendence Theory, 574
Doris D. Coward
30 Carolyn L. Wiener and Marylin J. Dodd: Theory of Illness Trajectory, 593
Janice Penrod, Lisa Kitko, and Gwen McGhan
31 Georgene Gaskill Eakes, Mary Lermann Burke, and Margaret A. Hainsworth:
Theory of Chronic Sorrow, 609
Ann M. Schreier and Nellie S. Droes
32 Phil Barker: The Tidal Model of Mental Health Recovery, 626
Nancy Brookes
33 Katharine Kolcaba: Theory of Comfort, 657
Thérèse Dowd
34 Cheryl Tatano Beck: Postpartum Depression Theory, 672
M. Katherine Maeve
35 Kristen M. Swanson: Theory of Caring, 688
Danuta M. Wojnar
36 Cornelia M. Ruland and Shirley M. Moore: Peaceful End-of-Life Theory, 701
Patricia A. Higgins and Dana M. Hansen
UNIT VI The Future of Nursing Theory
37 State of the Art and Science of Nursing Theory, 712
Martha Raile Alligood
Index, 721
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n Searching for specialized nursing knowledge led nurse scholars to theories
that guide research, education, administration, and professional practice.
n Nursing followed a path from concepts to conceptual frameworks to models
to theories, and finally to middle range theory, in this theory utilization era.
n Nursing history demonstrates the significance of theory for nursing as a
division of education (the discipline) and a specialized field of practice
(the profession).
n Knowledge of the theory development process is basic to a personal
understanding of the theoretical works of the discipline.
n Analysis facilitates learning through systematic review and critical reflection
of the theoretical works of the discipline.
n Theory analysis begins the process of identifying a decision making
framework for nursing research or nursing practice.
Evolution of Nursing Theories
“The systematic accumulation of knowledge is essential to progress in any
profession . . . however theory and practice must be constantly interactive.
Theory without practice is empty and practice without theory is blind.”
(Cross, 1981, p. 110).
Introduction to Nursing Theory:
Its History, Significance, and Analysis
Martha Raile Alligood
C H A P T E R 1
Bixler, 1959; Chinn & Kramer, 2011; George, 2011;
Im & Chang, 2012; Judd, Sitzman & Davis, 2010;
Meleis, 2007; Shaw, 1993).
This text is designed to introduce the reader to nursing theorists and their work. Nursing theory
became a major theme in the last century, and it con-
tinues today to stimulate phenomenal professional
growth and expansion of nursing literature and edu-
cation. Selected nursing theorists are presented in
this text to expose students at all levels of nursing
to a broad range of nurse theorists and various types
of theoretical works. Nurses of early eras delivered
excellent care to patients; however, much of what
was known about nursing was passed on through
forms of education that were focused on skills and
functional tasks. Whereas many nursing practices
seemed effective, they were not tested nor used uni-
formly in practice or education. Therefore, a major
goal put forth by nursing leaders in the twentieth
century was the development of nursing knowledge
on which to base nursing practice, improve quality of
care, and gain recognition of nursing as a profession.
The history of nursing clearly documents sustained
efforts toward the goal of developing a specialized
body of nursing knowledge to guide nursing practice
(Alligood, 2010a; Alligood & Tomey, 1997; Bixler &
Previous authors: Martha Raile Alligood, Elizabeth Chong Choi, Juanita Fogel Keck, and Ann Marriner Tomey.
This chapter introduces nursing theory from three
different perspectives: history, significance, and anal-
ysis. Each perspective contributes understanding of
the contributions of the nursing theorists and their
work. A brief history of nursing development from
vocational to professional describes the search for
nursing substance that led to this exciting time in
nursing history as linkages were strengthened be-
tween nursing as an academic discipline and as pro-
fessional practice. The history of this development
provides context and a perspective to understand the
continuing significance of nursing theory for the dis-
cipline and profession of nursing. The history and
significance of nursing theory leads logically into
analysis, the third section of the chapter and final
perspective. Analysis of nursing theoretical works
and its role in knowledge development is presented
as an essential process of critical reflection. Criteria
for analysis of the works of theorists are presented,
along with a brief discussion of how each criterion
CHAPTER 1 Introduction to Nursing Theory: Its History, Significance, and Analysis 3
and individual hospital procedure manuals (Alligood,
2010a; Kalisch & Kalisch, 2003). Although some nurs-
ing leaders aspired for nursing to be recognized as a
profession and become an academic discipline, nursing
practice continued to reflect its vocational heritage
more than a professional vision. The transition from
vocation to profession included successive eras of his-
tory as nurses began to develop a body of specialized
knowledge on which to base nursing practice. Nurs-
ing had begun with a strong emphasis on practice,
and nurses worked throughout the century toward
the development of nursing as a profession. Progress
toward the goal of developing a specialized basis for
nursing practice has been viewed from the perspec-
tive of historical eras recognizing the thrust toward
professional development within each era (Alligood,
2010a; Alligood & Tomey, 1997).
The curriculum era addressed the question of
what content nurses should study to learn how to be
a nurse. During this era, the emphasis was on what
courses nursing students should take, with the goal
of arriving at a standardized curriculum (Alligood,
2010a). By the mid-1930s, a standardized curriculum
had been published and adopted by many diploma
programs. However, the idea of moving nursing edu-
cation from hospital-based diploma programs into
colleges and universities also emerged during this
era (Judd, Sitzman & Davis, 2010). In spite of this
early idea for nursing education, it was the middle of
the century before many states acted upon this goal,
and during the second half of the twentieth century,
diploma programs began closing and significant
numbers of nursing education programs opened in
colleges and universities (Judd, Sitzman, & Davis,
2010; Kalisch & Kalisch, 2003). The curriculum era
emphasized course selection and content for nursing
programs and gave way to the research era, which
focused on the research process and the long-range
goal of acquiring substantive knowledge to guide
nursing practice.
As nurses increasingly sought degrees in higher
education, the research emphasis era began to emerge.
This era began during the mid-century as more nurse
leaders embraced higher education and arrived at a
common understanding of the scientific age—that
research was the path to new nursing knowledge.
Nurses began to participate in research, and research
courses were included in the nursing curricula of early
contributes to a deeper understanding of the work
(Chinn & Kramer, 2011).
History of Nursing Theory
The history of professional nursing began with Flor-
ence Nightingale. Nightingale envisioned nurses as
a body of educated women at a time when women
were neither educated nor employed in public service.
Following her wartime service of organizing and car-
ing for the wounded in Scutari during the Crimean
War, Nightingale’s vision and establishment of a School
of Nursing at St. Thomas’ Hospital in London marked
the birth of modern nursing. Nightingale’s pioneering
activities in nursing practice and education and her
subsequent writings became a guide for establishing
nursing schools and hospitals in the United States at
the beginning of the twentieth century (Kalisch &
Kalisch, 2003; Nightingale, 1859/1969).
Nightingale’s (1859/1969) vision of nursing has
been practiced for more than a century, and theory
development in nursing has evolved rapidly over the
past 6 decades, leading to the recognition of nursing
as an academic discipline with a specialized body
of knowledge (Alligood, 2010a, 2010b; Alligood &
Tomey, 2010; Bixler & Bixler, 1959; Chinn & Kramer,
2011; Fawcett, 2005; Im & Chang, 2012; Walker &
Avant, 2011). It was during the mid-1800s that Night-
ingale recognized the unique focus of nursing and
declared nursing knowledge as distinct from medical
knowledge. She described a nurse’s proper function
as putting the patient in the best condition for …

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