On the Way to Theoretical Nursing:Stages and Milestones
Despite the barriers against theoretical thinking and theorizing
identified in the previous chapter, nurses, in caring for human beings
in an orderly and organized way, have always been involved in some form
of theorizing. Concepts of care, comfort, communication, protection,
healing, and health, among others, were used to guide clinical practice
before they were labeled as concepts and before they were linked
together to form nursing theories. However, between 1950 and 1980, a
process of serious labeling and a more systematic communication of
concepts and theories occurred. This process continues to enrich the
discipline of nursing.
First attempts in theoretical nursing were made by Florence Nightingale
in the late 19th and early 20th centuries to describe nursing focus and
action in the Crimean War.Nightingale was prompted to articulate her
ideas in numerous publications, with different goals. Among these goals
were gaining support for a national need for nurses, achieving
acceptance for the development of educational programs for nurses, and
exposing the unhealthy environmental conditions that were endured by
English soldiers during wars.
Subsequent attempts in theorizing were published by American nurse
educators in the mid- 1950s, prompted by the need to justify different
educational levels for nurses and the need to develop curricula for each
of the educational levels in nursing. To differentiate curricula, and to
enhance the quality of education in each curriculum, a few pioneer
nurses combined their clinical expertise with forward vision to answer
such questions as “What are nursing goals?” and “What ought to be the
aims of nursing?” These early theorists were aware that by developing
programs that represented a nursing perspective, they would help nursing
students—that is, future clinicians—to focus on nursing phenomena and
problems rather than on medical phenomena and problems. Groups were
formed in different parts of the United States (and subsequently or
simultaneously in other parts of the world) and committees were formed
to discuss the nature of nursing, the nature of nurses’ work, and the
unique aspects of nursing. The goals of these early efforts were also
focused on differentiating nursing from other health science
disciplines. These dialogues went further to explore the nature of
Perhaps the best way to consider the history of nursing theory and to
analyze nurses’ current interest in theory in perspective is to consider
dominant themes in the different stages of the development of nursing
knowledge (see discussion on Nursing Perspective in Chapter 6). The
implicit assumption here is that the themes discussed in the literature
are indicative and representative of what members of the discipline were
interested in at different times during the process of its development.
In addition to delineating these themes, an analysis of the
theory-literature provides us with specific milestones that may have
helped in the development of theoretical nursing. Both approaches
provide insights into how nursing evolved into its current status.
In this chapter, the themes are articulated as stages that have
influenced progress in knowledge development. Stages are complemented by
milestones, which characterize the turning points for moving from one
stage to the next. These stages and milestones helped achieve the
current level of progress in the discipline.
STAGES IN NURSING PROGRESS
Since the time of the Crimean War, nursing has gone through many stages
in its search for a professional identity and in defining its domain. It
is interesting to note that our analysis and evaluation of nursing’s
theoretical thought, the patriarchal societies we live in, and the view
and status accorded nurses and nursing may make it appear as if each of
these stages was a deviation from the goal of establishing the
discipline of nursing. However, each of these stages has indeed
sharpened and clarified the dimensions needed for the establishment of
the scientific aspects of the discipline, promoting or leading to a
scholarly evolution of the nursing discipline. Each stage has helped
nurses come closer to identifying the domain of nursing, defining its
mission, and defining its theoretical base. Progress in the development
of theoretical nursing is definable in terms of six stages: practice,
education and administration, research, theory, philosophy, and
Stage of Practice
The Western version of nursing as an occupation dates from the late 19th
century and the early 20th century, a product of the Crimean War.
Because of the need to care for wounded soldiers, Florence Nightingale
organized a group of women to deliver care under her supervision and
that of the war surgeons. Nightingale focused on hygiene as her goal and
environmental changes as the means to achieve that goal.
The Eastern version of the beginning of nursing gives credit to Rufaida
Bent Saad al-Aslamiya (also referred to as Koaiba Bent Saad), who
accompanied the prophet Mohammed in his Islamic wars. She, too,
organized a group of women and focused on hygiene and environment in
caring for the wounded. She established special moving tents to attend
to the sick, the wounded, and the disabled. She modeled first aid,
emergency care, and long-term healing and caring. She cared for patients
and trained women in the arts of first aid and nursing (Fangary, 1980;
S.H. Hussein, personal communication, 1990). Like Nightingale,
al-Aslamiya established the first school of nursing in the Muslim world.
In addition, she conceptualized a code of ethics for nurses and inspired
young women to be educated (Jan, 1996). Like Nightingale, her role in
nursing did not end with the war. al-Asalmiya continued to advocate for
health care, preventive care, and health education.
开班护理的东面版本赋予Rufaida Bent Saad al-Aslamiya（也号称Koaiba Bent
Hussein (1981) described al-Aslamiya’s devotion to nursing and her
success in establishing new rules and traditions for quality nursing
care as precursors to modern nursing in the Middle East. In both Eastern
and Western versions of the beginnings of nursing, a woman saw the need
for organizing other women to care for the wounded in wars; in both,
they provided emergency care as well as long-term care. They both
focused on caring, healing, promoting healthy environments, and on
training other nurses. They both were driven by moral commitments to
alleviate suffering and enhance healing.
Therefore, during this stage, the mission of nursing was defined as
providing care and comfort to enhance healing and a sense of well-being,
and to create a healthy environment that helps decrease suffering and
deterioration. Nurses defined their domain to include the patient and
the environment in which the care is offered. Both Nightingale and
al-Aslamiya created and monitored the environment in which the care was
being given. The stage of practice gave nursing its raison d’être, its
focus, and its mission. Theoretical writings by Nightingale (1946)
describing the care goals and processes are testimony to the potential
for nurses to articulate practice activities theoretically. These
writings also point to the potential for nursing as a field of practice
to be articulated theoretically.
Stage of Education and Administration
From that early focus on practice and the concomitant traditions of
apprenticeship and service, there was a shift to questions related to
training programs and nursing curricula. The “how to” of practice
eventually was translated into what curriculum to develop to support
different levels of nursing education and how to teach it. Almost three
decades were spent experimenting with different curricula, ways of
preparing teachers, modes of educating administrators for schools of
nursing and for service, and ways of preparing nurse practitioners.
During this stage, the focus was on the development of functional roles
for nurses. The dominant themes of this stage evolved from the
educational and administrative roles of nurses.
The significance of this stage in the theoretical development of the
discipline lies in the impetus it provided nurses to ask questions
related to the domain of nursing. In developing curricula geared toward
preparing nurses for different educational levels, nurses asked: What is
nursing? How different is nursing care as provided by a diploma
graduate, an associate-degree graduate, a bachelor of science graduate,
or a master’s-degree graduate? These questions prompted nurses to
articulate the core of nursing practice in more theoretical terms
(Henderson, 1966). In a curious way, it is during this stage that the
theoretical ideas of the pioneering American nurse theorists were born.
A focus on teaching and education, therefore, may have paved the way for
the further development of theoretical nursing.
Stage of Research
The stage of research evolved through a series of events overlapping
with the stages of practice and education. As Gortner (2000) indicated,
during the 1920s, case studies were formulated as teaching tools, but
they also were used as an impetus for standardization. Systematic
evaluation of these cases triggered the need for graduate education
during the post-Depression years in the United States. The war years
required data collection and analysis, necessitating the establishment
of the Division of Nursing Resources as part of the U.S. Public Health
Services in 1948. The beginnings of a research enterprise were born. In
the 1970s, commissions and councils of nurse researchers were
established. Nurses increasingly were receiving graduate degrees in
other disciplines, funds for National Research Service awards were
established, and nursing research journals were initiated.
The momentum in nursing in education, curriculum development, teaching
and learning strategies, and in administration also led educators to
pursue research. Experts in nursing curricula recognized that without
research and a systematic inquiry into, for example, the different
teaching/learning modalities and the teaching/learning milieu on
outcomes, the education of nurses could not be improved. Therefore, the
research interest emerged from and focused on questions related to
educational and evaluative processes. The scholarship in teaching
dominated the early research enterprise.
How to teach, how to administer, how to lead, and which strategies would
be more effective in teaching and administering were questions that led
to the development and expansion of nursing research (Gortner and Nahm,
1977). The first nursing research journal—entitled Nursing Research— in
the world was established in 1952, in the United States, and the
Southern Regional Educational Board (SREB) and the Western Council for
Higher Education in Nursing (WCHEN) were founded in the mid-1950s and
mid-1960s, respectively. Their objectives called for improving nursing
education, enhancing nursing research productivity, and raising the
quality of research. The journal and the meetings of the SREB and WCHEN
helped nursing develop its scientific norms—that “set of cultural values
and mores governing the activities termed scientific” (Merton, 1973, p.
Criteria for reviewing scientific papers were established, on the basis
of the assumption that scientific inquiry must be judged by peers.
Therefore, nurse researchers began to abide by Merton’s norm of
universalism, the impersonal evaluation of a research product by some
objective criteria (Merton, 1973, p. 270). Universities also held the
same expectations for nursing faculty that they held for other faculty;
specifically, members of faculty in schools of nursing were required to
develop their ideas and communicate them in the scientific arena through
publications in refereed journals and scholarly presentations in
meetings. Therefore, when seen in the context of science, the “publish
or perish” dogma was not unrealistic but was rather another norm
governing nursing science. Nurses were now involved in that
communality—the sharing of ideas—and their research was subjected to the
scrutiny of their peers and anonymous critics (Gortner, 1980; Merton,
Nursing’s initial attempts at introducing ideas and sharing research
results were met with severe and, at times, devastating criticisms from
other nursing colleagues. (Those who participated in early research
conferences may remember the lengthy and severe research critiques that
traumatized researchers and audience alike. These authors of these
critiques may not have considered the stage of nursing research
development.) As a result, and in addition to universality and
communality, two other norms evolved: objectivity and detached scrutiny.
Objective criteria for research evaluation, which were identified and
shared, provided a turning point—a scholarly medium for research
refinement and further development (Leininger, 1968).
The stage of research development made major contributions to
contemporary scholarly nursing. It was also the stage in which tools of
science left a major mark on curricula through the new offerings of
research classes and statistics courses and through the several
publications in which major research tools and instruments were compiled
These stages have a global parallel. Progress in knowledge development
is also influenced by international levels of education. Some countries,
such as Australia and Germany, moved nursing education from hospital
training to university training in the 1980s and 1990s, respectively.
Subsequently, there has been a steady increase in philosophies and
theoretical dialogues, as well as a cumulative trajectory of research
These, then, were the beginnings of nursing inquiry and science. During
this stage, as in other sciences, researchers emphasized scientific
syntax—the process rather than the content of research (Kuhn, 1970). The
binding frameworks or depositories of collected facts were still
lacking. Nevertheless, the syntax of the discipline had been formulated.
Stage of Theory
Below is a list of 100 things you can do with a any number of different
types of nursing degree. Some of these positions do require
specializations and many will need you to hold a master’s degree (MSN)
Eventually, the fundamental questions about the essence of nursing—its
mission and its goals—began to surface in a more organized way. An
incisive group of leaders, nurses who believed that theory should guide
the practice of nursing, wrote about the need for theory, the nature of
nursing theory, philosophers’ views of theory, and how nursing theory
ought to be shaped. Although the conceptual schemata of nurse theorists
for the discipline of nursing appeared during the education and
administration stages of the discipline, it was not until the emergence
of the stage of theory that they were taken seriously (Nursing Theory
Think Tank, 1979).
最终，关于护理本质的大旨难题 – 其职责和指标 –
西奥ry Think Tank，1979）。
During this stage, arguments arose about whether nursing was merely a
chapter of medicine or whether it was part of the biologic, natural, or
physical sciences (analogous to the earlier Cartesian concept that
biology is simply a chapter of physics). The Cartesian concept was
rejected (biology is indeed a distinct and autonomous science), and
nursing continued to resist the implication that it was a part of
medicine. It became clear to a new breed of nurse leaders—the
philosophers and the theorists (or conceptualists, as some referred to
them)—that nursing could not be reduced to a single science that
inquires into just one aspect of man, just as biology is not reducible
to physics. Nursing is complex, necessitating its intrinsic autonomy in
content and methods.
- 国学家和理论家（大概概念主义者，仿佛她们提到的那一个人）而言 –
The search for conceptual coherence evolved from a preoccupation with
syntax to the disciplined and imaginative study of the realities of
nursing and the meaning and truths that guide its actions (Table 5-1).
Its development from preoccupation with scientific method to speculation
and conceptualization is reminiscent of the development of philosophical
thought in the 18th and 19th centuries. The 18th century was greatly
influenced by Newton and by Bacon, who was in turn influenced by
Descartes. The 19th century was dominated by Kant, whose hypothetical,
deductive, and metaphysical approach encouraged the speculative nature
of science. The speculators in nursing began to construct realities as
they saw them, and their imaginative constructs evolved from their
philosophical backgrounds and from their educational inclinations.
CHARACTERISTICS OF THE BEGINNING STAGE OF THEORY DEVELOPMENT
• 利用外部范式来指导理论 • 关于学科现象的不确定性 • 离散和独立的理论 • 研究，实践和理论之间的分离 • 寻求概念上的一致性 • 用于课程的理论 • 单一范例的目标占上风
It was natural for theory development to be influenced by the paradigms
of other disciplines, by the educational background of nurse theorists,
and by the philosophical underpinnings of the time. Therefore, we find
premises stemming from existentialism, analytical philosophy, and
pragmatism guiding the development of those theories, sometimes
explicitly and often implicitly. Nurses also adopted concepts and
propositions from other paradigms, such as psychoanalysis, development,
adaptation, and interaction, as well as from humanism, to guide its
assessment and its action. Theories were developed in response to
dissatisfaction with isolated findings in research. The emerging
theories addressed the nature of the human being in interactions and
transactions with the health care system, as well as the processes of
problem solving and decision making for assessment and intervention.
Although certain theoretical concepts were synthesized from diverse
paradigms, most nursing theories, such as subsystems of behavior, role
supplementation, therapeutic touch, and selfhelp, were definable and
analyzable only from the nursing perspective. Theories offered a
beginning agreement on the broad intellectual endeavors and the
fundamental explanatory tasks of nursing. This stage offered knowledge
of relevant phenomena, but uncertainty continued about the discipline of
nursing and its intellectual goals. Just as in nuclear physics—when the
first achievement was not one of observation or mathematical calculation
but one of intellectual imagination— conceptual schemata evolved before
there was any clear recognition of nursing’s empirical scope. In
nursing, theories helped the discipline to focus on its concepts and
- 当首个到位不是观测或数学计算之一，而是智力想象 –
Rogers (1970) offered a conception of nursing that focused on the
constant human interaction with the environment. Johnson (1980)
developed the notion that a human being—a biologic system—is also an
abstract system of behavior centered on innate needs. Levine (1967) and
Orem (1971) proposed guidelines for nursing therapeutics that preserve
the integrity of the human being, the psychology, the community
affiliation—in short—the entire person. Orem (1985) reminded us that the
human being is perfectly capable of self-care and should progress toward
- 海洋生物系统 –
Because of the earlier focus on education and professional identity,
because the National League for Nursing stipulated a conceptual
framework for curricula, and because the truth of a theory had not yet
been established using the empirical positivists’ criteria of
corroboration, emergent theories were not used to guide practice or
research but were instead used to guide teaching. Consequently,
scientific energies were dissipated in developing curricula that
corresponded to these theories.
Although theories may have influenced practice through students, such
influence was not documented in the literature, which focused more on
theory in educational programs. As an educator who was a member of a
school that used nursing theory (also called a model) as a framework for
the curriculum, I experienced first-hand, in the mid-1960s, the
conflicts that graduates of the program encountered when they wanted to
use a nursing framework, one that they studied and experienced in their
educational program, in practice and were unable to do so because of its
novelty and its esoteric concepts. Whether the use of nursing models in
education rendered nursing care more effective and efficient is a matter
left to speculation and was evidenced only in isolated incidents and
through experiential narrative analyses that were discounted for their
lack of universality and generalization. The graduates of programs based
on nursing theories in the early and mid-1960s should be encouraged to
write the stories of their experiences with these theoretically based
programs and the ways by which their practice was informed or not
informed by these programs.
The nagging questions continued: • What frameworks enhance safety in nursing practice? • What are the goals of nursing care? • What are the desired outcomes related to nursing care? • How do nursing interventions relate to desired outcomes? • What are the quality care criteria by which to judge nursing practice? 唠叨问题仍在继续： • 哪些框架可以提高护理实践的安全性？ • 护理的目标是什么？ • 与护理有关的理想结果是什么？ • 护理干预如何与预期结果相关联？ • 什么是评判护理实践的质量护理标准？
These questions continued to lead to one type of answer: Let us find a
guiding paradigm or search for a universal theory with explanatory power
for all dimensions of nursing and, once we find this all-encompassing
theory, we will be able to answer questions related to the discipline.
This approach reminds us that Galileo and Descartes talked of the
scientist’s task as that of being able to decipher once and for all the
secrets of nature and to arrive at the “one true structure” of the
nature of the world. However, that was a Platonic ideal rather than a
plain description of the task of scientific research. Later, scientists
began to discard this line of pursuit. Physicists and physiologists “now
believe that . . . we shall do better in these fields by working our way
toward more general concepts progressively, as we go along, rather than
insisting on complete generality from the outset” (Toulmin, 1977, p.
387). Toulmin proposed that “human behavior in general represents too
broad a domain to be encompassed within a single body of theory” (p.
387). When scientists accept the need for multiple theories, and when
they accept the process nature of science, it will be a “sign of
maturity rather than defeatism” (p. 387) within the discipline.
Because nurse scientists searched for one theory for the entire
discipline, the task was either overwhelming and too highly abstract
(Rogers, 1970), or too simplistic and reductionist (Orem, 1971). The
sentiment of practitioners was to question the possibility and
usefulness of an allencompassing theory, as evidenced by the meager
literature throughout the 1960s and 1970s on nursing practice using
nursing theory. The desire for a single conceptual framework to guide
the nursing curriculum was carried to nursing practice. Nurse
practitioners came to believe that they were being asked to make a
choice between theories, and then adhere to that one particular theory.
Because none of the theories addressed all aspects of nursing, nurse
practitioners avoided nursing theory, ignored it, or refused to use it.
A myth was being formed. However, many nurses abandoned the notion of a
universal theory to describe and explain nursing phenomena and units of
analysis and to guide nursing practice, just as physicists did when they
abandoned the 17th-century hope that a universal science of nature could
be developed within the framework of fundamental ideas of classical
Three themes in nursing that evolved during this stage were acceptance
of the complexity of nursing and the inevitability of multiple theories;
acceptance of the need to test and corroborate major propositions of
differing theories before dismissing any of them; and the idea that
concepts or theories remaining in the field, through a cumulative
effect, become the basis for the development of a specific perspective.
Dualism and pluralism were the norms during the stage of theory. It was
also during this stage that nursing developed the boundaries necessary
to focus its inquiry and the flexibility necessary to allow expansion
through creative endeavor.
- Psychiatric Mental Health Nurse
Stage of Philosophy
Work with people with psychiatric problems in hospitals or psychiatric
wards and prisons.
As nurses began reflecting on the conceptual aspects of nursing
practice, on defining the domain of nursing, and on the most appropriate
methods for knowledge development, they turned to philosophical
inquiries. The focus during this stage was on raising and answering
questions about the nature of nursing knowledge (Carper, 1978; Silva,
1977), the nature of inquiry (Ellis, 1983), and the congruency between
the essence of nursing knowledge and research methodologies (Allen,
Benner, and Diekelman, 1986). During this stage, philosophy was
considered an attempt to understand the philosophical premises
underlying nursing theory and research (Sarter, 1987) and an attempt to
develop philosophical inquiry as a legitimate approach to knowledge
development in nursing (Fry, 1989).
This stage influenced profoundly the intellectual discourse in nursing
literature. During this stage, epistemological diversity was accepted
and the need for ethical, logical, and epistemological inquiries was
legitimized, as evidenced in the numerous philosophically based
manuscripts accepted for publication (Ellis, 1983).
This stage was also marked by a scholarly maturity in the discipline, as
its members acknowledged the limitation of appropriate tools to
investigate fundamental and practical issues. Assumptions about
wholeness of human beings, contextual variables, and holism of care
called for congruent investigative tools, and nurse scholars
acknowledged the complexity of capturing nursing phenomenon using
existing tools (Newman, 1995; Stevenson and Woods, 1986). Accepting
limitations while maintaining the reality of the contextuality and
complexity of the phenomenon represents a marked scholarly maturity and
the potential to focus on the development of appropriate tools.
Earlier during this stage, discussions encompassed the different “ways
of knowing” in nursing and espoused a call for going beyond the
empirical (Carper, 1978). These epistemological discussions focusing on
the structure of knowledge, nature of theory, criteria for analysis, and
justification of particular methodologies for knowledge development
significantly contributed to the discovery and construction of an
identity for the discipline of nursing. As theorists and metatheorists
discussed the philosophical bases that shaped nursing knowledge (Allen
et al., 1986; Roy, 1995), a new set of questions emerged. These
questions reflected more the values and meaning of the knowledge being
developed and the consequences of this knowledge on nursing practice,
and focused less on the structure and justification of knowledge
(Bradshaw, 1995; Silva, Sorrell, and Sorrell, 1995).
The emphasis on knowing was complemented by another emphasis on “being.”
The being was not limited to the nurse, or to the patient, but to each
separately and to both joined in caring interactions (Benner, 1994;
Newman, 1995). This philosophical stage, encompassing both components of
epistemology and ontology, provided nurses with the legitimacy to ask
and answer questions related to values, meanings, and realities using
multiple philosophical and theoretical bases.
This philosophical stage persists, overlapping with the following stage
of integration. Dialogues about postcolonialism provide the
philosophical canons for understanding how domination, power, and
resistance influence health care encounters at all different levels,
from the individual to society (Kirkham and Anderson, 2002). The
postcolonial scholarship in nursing was informed by the discourse in the
discipline on race, culture, ethnicity, diversity, and power
differential. It refers to and frames the theoretical and empirical work
of people’s experiences living under the oppression of colonial control.
Using this philosophical stand, we can better understand the effects of
diversity in color, religion, sexual preference, ethnicity, and class in
shaping responses to health and illness. It allows health care
professionals to access the meaning of marginalization.
Postmodernism, a reaction by philosophers to positivism, translated in
nursing into a prevailing sentiment described by Whall as “Let’s get rid
of all nursing theory” (Whall, 1993; Whall and Hicks, 2002). Although
the context is vital to postmodernism philosophy, universal totality is
not possible. Other concepts that characterize postmodernism are
relativism, deconstruction, context, atheoretical narratives, and
- Physician’s Office Nurse
Stage of Integration
Work directly with people and the job tends to be 9 to 5.
This stage has seven universal characteristics, each described in the
subsequent text. They should be used to stimulate thinking and
discussions about the state of development of our discipline, both
nationally and internationally. This stage differs from the next stage
in its internal versus external integration with other disciplines. A
first characteristic of this stage is the use of substantive dialogues
and discussions focused on identifying coherent structures of the
discipline of nursing at large and of its specific areas of
specialization (Schlotfeldt, 1988). The structures include scientific,
theoretical, philosophical, and clinical knowledge that is focused on
the nursing domain and its phenomena. These dialogues take place in
conferences, think tanks, and themed journal editions devoted to the
development of middle-range and situation-specific theories focused on
an aspect of nursing.
A second characteristic of this stage is the development of educational
programs that are organized around substantive areas through the
integration of theory, research, and practice— such as environment and
health, symptom management, or transitions and health. It is also
manifested in the ease by which nursing administrators, clinicians, and
educators use theoretical nursing, and in the increasing dialogue among
members of the discipline regarding matters related to knowledge,
discovery, and development that is focused on and emanates from the
domain of nursing.
A third characteristic of this stage is the evaluation of different
aspects of theoretical nursing by members of the discipline—nursing
clinicians, teachers, administrators, researchers, and theoreticians.
Evaluation is not limited to theory testing; it includes description,
analysis, and critiques as well. Each of these processes is important in
the development and progress of our discipline because of its diverse
A fourth characteristic of this stage is the attention that members of
the discipline give to the strategies of knowledge development that are
congruent with the discipline’s shared assumptions and that consider the
conditions of holism, patterning, experience, and meaning (Newman,
A fifth characteristic is the involvement of members of specialty fields
in developing theories that are pertinent to the phenomena of that
particular field. This involvement does not preclude similar attention
to theories related to phenomena of the domain of nursing at large; for
example, theories to describe and intervene in symptoms.
A sixth characteristic is the critical reappraisal of philosophical and
theoretical underpinnings that have guided the definitions and
conceptualizations of the central concepts of the nursing domain, as
well as the methodologies used to generate knowledge. An example of such
discourse is the reappraisal of the definition of client in the nursing
literature and the congruency of these definitions with domain
assumptions (Allen, 1987). Another example is the dialogue about melding
different methods to generate knowledge that is more congruent to the
tenets of a human science, such as grounded theory, feminist theory, and
critical theory (Kushner and Morrow, 2003).
A seventh characteristic of this stage is the creative ways by which
academic institutions in nursing become involved with patient care,
either through academically run clinics (nursing clinics), or by
developing clinically based faculty positions.
- Nurse Case Manager (案例管理)
Stage of Interdisciplinarity
You will need an MSN degree for this role.
The stage of integration leads and overlaps the stage of
interdisciplinarity. The road map for the National Institutes of Heath
(NIH) at the beginning of the 21st century provided a strong impetus for
a different type of integration, one that challenged members of
different disciplines to build programs of research that incorporate the
theories and evidence from different fields. Although nursing has
consistently depended upon, borrowed from, and shared the research and
theories of other disciplines, the drive for interdisciplinary education
and teaching research was now being promoted at leading research
institutions. A central tenet of this stage is the forging of
relationships between researchers and clinicians who are members of
different disciplines, to develop joint institutes, advance research
programs, or to provide more comprehensive education. Centers for sleep
research, pain management, palliative care, complementary and
alternative practices, safe practice, and gun-shot injuries are examples
of areas that require the expertise of members of different disciplines.
A similar move to reflect the nature and complexity of science was
initiated at the NIH. The question that drove these institutes was
whether they should reflect discipline or an area of science. Time will
tell whether a move away from disciplinary institutes will continue to
support the development of disciplines horizontally as well as
vertically. More discussion of disciplines and interdisciplines is
provided in Chapter 14.
- Nursing Informatics Specialist
Stage of Technology and Information Systems
This requires an MSN degree specialization.
Health care records, robotic medication dispensers, tele-home care,
long-distance monitoring, virtual surgeries, and voice mail reminders of
appointments and medications are characteristic of this stage in the
history of the development of the nursing discipline. Theories that
incorporate variables and conditions related to informatics and
technological breakthroughs are necessary drivers for this stage.
Self-care practices take on different meanings for individuals and
families when they incorporate the most advanced and up-to-date
information disseminated by scientists and clinicians to the public via
the internet. Self-care practices and goals also incorporate the use of
such new monitoring devices as home blood pressure apparatus, glucose
kits, self-diagnosis protocols, and self-monitoring gadgets. The ability
to sort among accurate and inaccurate information, and the alternative
“if-then” scenarios that result, will need to be guided by
situation-specific theories that incorporate guidelines for clinicians
and consumers (An, Hayman, Panniers, and Carty, 2007).
THEORY DEVELOPMENT IN NURSING: MILESTONES
- School Nurse
Work directly with children. You will have some time off during school
MILESTONES IN THEORY DEVELOPMENT
- Legal Consultation Nurse
The progress and development of theoretical nursing is marked by several
milestones, which are identified through an analysis of theoretical
literature that appeared in selected nursing journals between 1950 and
- These milestones substantially changed the position of theory in
nursing and profoundly influenced the further development of theoretical
nursing. Each milestone is defined and briefly described here (Table
5-2). Identifying and defining these milestones challenges others to
explore the impact each milestone may have had on the progress and
development of nursing knowledge.
Relates to the handling of medical malpractice cases.
Prior to 1955—From Florence Nightingale to Nursing Research
- Research Nurse (研究)
壹玖伍贰年事先 – 从弗Loren斯南丁格尔到护理切磋
The significant milestone of the period before 1955, which has
influenced the subsequent development of all nursing science, was the
establishment of the journal, Nursing Research, with the goal of
reporting on scientific investigations for nursing by nurses and others
(Fig. 5-1). The journal’s most significant goal was to encourage
scientific productivity. The establishment of the journal confirmed that
nursing is indeed a scientific discipline and that its progress will
depend on whether nurses pursue truth through an avenue that respectable
disciplines take, namely, research. Although Nightingale may have
provided the beginning impetus for research and theory, initially, her
impact was most keenly felt in nursing education. Education of nurses
had predominantly occurred in diploma programs, but this period marked a
beginning interest in providing different routes for nurses’ education.
This period was otherwise uneventful for nursing theory, except that the
establishment of nursing research publications provided the framework
for a questioning attitude that may have set the stage for inquiries
that led to more theoretical discourses in later years.
Chronology of the development of theoretical nursing
Gives you the opportunity to pave the way for the future.
1955–1960—The Birth of Nursing Theory: The Columbia University Teachers College Approach
- Diabetes Management Nurse
壹玖伍伍-一九六〇年 – 护理理论的出生：哥大师范高校方法
Although Florence Nightingale’s ideas about nursing, focusing on the
relationship between health and environment, were developed in the early
1900s, it was not until the mid-1950s that nurses began to articulate a
theoretical view of nursing. Questions about the nature of nursing, its
mission and goals, and about nurses’ roles drove nurse educators to
capture the answers to these questions and present them in a more
coherent whole. These questions grew out of an interest in changes in
the educational preparation of nurses from diploma to baccalaureate
programs, out of concerns about what to include or exclude in curricula,
and about what nurses needed to learn to function as nurses.
Columbia University’s Teachers College, where the first professor of
nursing, M. Adelaide Nutting, was appointed, offered graduate programs
that focused on education and administration, to prepare graduates as
expert educators and administrators. Although the focus of that
visionary program was not on nursing science or nursing theory,
participants in this program must have felt that they were in an
environment that promoted dialogue and debate of philosophical and
theoretical questions. Of note, in 1999, the nursing education program
celebrated 100 years of influence, a well-placed celebration given that
most theorists who offered a conception of nursing during that decade
were educated at Teachers College; these included Peplau, Henderson,
Hall, Abdellah, King, Wiedenbach, and Rogers (Table 5-3).
TABLE 5-3 NURSING THEORISTS: 1950–1980
Work directly with people with diabetes, helping them manage their
|1963年||D. Howland和E. McDowell。“医院系统模型”。|
|1964年||D. Howland和E. McDowell。“病人护理的测量：概念框架。”|
|1966年||M. Harms和F. McDonald。“一个新的课程设计。”|
Being prepared for functional roles and experiencing a sense of
competency in preparing syllabi, setting staffing patterns, and so on
may have freed the creative abilities of these scholars for other
aspects of the scholarly process, such as theory or conceptual model
development. And, although other experiences and programs may have
directly influenced these scholars in their theoretical pursuits (e.g.,
Rogers’ doctoral preparation at Johns Hopkins), it appears that the
philosophy of Teachers College indirectly left an impact, not only on
psychiatric theory and research, but also on theoretical thinking in all
of nursing (Sills, 1977). Asking and answering questions about the
influence of scholarly environments on preparing productive scholars may
have stimulated the search for the nature of scholarship, which may have
led to questions related to the nature of the nursing identity.
Peplau (1952), using Harry Stack Sullivan’s theory title and concepts to
develop her own, produced the first articulated concept of nursing as an
interpersonal relationship, with components of interpersonal processes
central to nursing needing to be elucidated and analyzed. The field of
psychiatric nursing subsequently was substantially developed using
Peplau’s ideas. Other theories that evolved in the 1960s were based on
those early conceptions of nursing. For example, Virginia Henderson,
with Bershan Harmer, developed the early seeds of a nursing theory that
was published in the mid-1950s in a textbook on the principles and
practice of nursing.
The request from the International Council of Nursing (ICN) to define
nursing and its mission led to the subsequent ICN statement in 1958 that
appeared in a publication with wide distribution and that was adapted
internationally (Henderson, 1966, p. 15). The message given by both
Peplau and Henderson was that nursing has a specific and unique mission
and that this mission has some order and organization that can be
communicated. These articulated wholes represented the beginnings of
theories in nursing.
Abdellah’s nursing theory, evolving from her work at Columbia
University, is another example of the influence of that school on
theoretical nursing (Abdellah, Beland, Martin, and Matheney, 1961).
Abdellah’s doctoral dissertation in 1953 at Teachers College, under the
leadership of Hildegard Peplau, focused on determining covert aspects of
nursing problems. The results of her research were subsequently
published in Nursing Research, marking the beginning of her attempts at
theorizing the nursing care process. Her conceptualization of nursing
care evolved from her dissertation research and from another study
completed in 1955, on the needs of patients for nursing care. The latter
was based on data collected from patients, nurses, and doctors. Abdellah
developed her conception of what nursing is by focusing attention on
patients rather than on techniques.
Ideas of other theorists were formulated around the need for a binding
framework to guide curricula, but their writing and publications did not
have the instant impact as that of Peplau, Henderson, and Abdellah on
theoretical nursing. Their conceptions were slow to have an impact on
nursing. Orem’s ideas were first published in a guide for developing a
curriculum for practical nursing in 1959. Patient needs were also the
focus. Hall developed, in 1959, and implemented, in 1963, a concept of
nursing based on needs and interpersonal relations at the Loeb Center
for Nursing and Rehabilitation. One can see the influence of both Peplau
and Henderson in her writing (Hall, 1963).
Independent of the Teachers College group of theorists, Johnson was
beginning to play a central role in conceptualizing nursing. Johnson’s
(1959) analysis of the nature of science in nursing was undoubtedly a
milestone in drawing attention to the potential of nursing as a
scientific discipline and in advocating the development of its unique
knowledge base. At that time, Johnson tentatively suggested that nursing
knowledge is based on a theory of nursing diagnosis that is distinct and
different from medical diagnosis. The substantive matter for such
diagnosis, the beginning of Johnson’s theory, was starting to be
formulated at this time. (See Chapter 20 for appropriate citations for
Another milestone in nursing progress was the establishment of the
special nursing research fellowship program to facilitate, support, and
encourage nurses’ education for research careers. This program provided
financial incentive and support for nurses to pursue their doctoral
education in related fields such as biology, physiology, sociology, and
anthropology, among others.
- Cruise Ship Nurse
1961–1965—Theory: A National Goal for Nursing
This is a fantastic opportunity for those who want to travel the world.
You will generally have a reasonably low workload, but you do have to be
on call around the clock.
From a reduced conception of a human being as “an illness” or “a
surgery,” with signs and symptoms, nursing theory in the late 1950s
refocused nursing attention on the individual as a set of needs and
nursing as a set of unique functions. Still, a reductionist approach to
nursing existed. The 1960s, with its turbulent society, the Camelot
goals of harmony and coexistence, and the influence of Peplau may have
prompted the refocusing of nursing from its stated mission of meeting
patients’ needs to the goal of establishing a relationship between the
nurse and client. If relationships are effectively established through
interpersonal interactions (as previously articulated by Peplau, 1952,
and as advocated by a new group of theorists), then nursing care can
meet the needs of the patient—not as defined by nurses, but as perceived
by the patient.
During this period, the Yale School of Nursing’s position, influenced by
the Columbia Teachers College graduates who became faculty members at
Yale, was beginning to be formulated. To these scholars, nursing was
considered a process rather than an end, an interaction rather than
content, and a relationship between two human beings rather than an
interaction between unrelated nurse and patient. Multiple social forces
helped the Yale group to develop its ideas into concepts of nursing.
Federal grant money was available for preparation ranging from
psychiatric nursing to teaching positions, for identifying psychiatric
concepts in nursing, and for developing an integrated curriculum. The
availability of time and resources, therefore, was significant in
providing the necessary push, as well as the appropriate environment in
which to reflect on nursing’s mission and goals.
Although the work of the faculty of the Yale School of Nursing may have
profoundly influenced nursing research in the United States in the
1960s, its influence on theory was not as marked at the time. A revival
of that impact came in the 1980s, as nurses acknowledged Yale’s
strategies for theory development; this is evidenced by the
reconsideration of Orlando’s work (Schmieding, 1983, 1987, 1988) and by
the paradigmatic shift in nursing research to phenomenology (Oiler,
1982; Omery, 1983; Silva and Rothbart, 1984). These writers’
conceptualization of nursing, therefore, was not the milestone that
prompted the evolution of the next stage of theory. Rather, it was the
position paper of the American Nurses Association (ANA)—in which nursing
was defined as care, cure, and coordination, and in which theory
development was identified as a most significant goal for the profession
of nursing—that may have been influential in the further development of
theoretical nursing (ANA, 1965).
Omery，一九八五; Silva and
Two other significant developments occurred during this period. First,
federal support was provided to nurses wishing to pursue doctoral
education in one of the basic sciences. The graduates of these programs
are those who, in the mid-1970s, further developed metatheoretical
ideas. The second development was the inauguration of the journal,
Nursing Science. Although shortlived, it was a medium for the exchange
of ideas on theory and science in nursing and a confirmation that
nursing is an evolving science with theoretical principles and
- Camp Nurse
1966–1970—Theory Development: A Tangible Goal for Academics
Work in summer camps involving children. However, there are also
increasing numbers of health-related camps, such as those for people who
1968-一九七零年 – 理论发展：学术界的实际目的
With the ANA’s recommendation that theory development was of highest
priority in the profession, and with the availability of federal
support, a symposium sponsored by Case Western Reserve University was
held as part of the nursing science program. This symposium was divided
into three parts. The part focusing on theory was held on October 7,
1967, and was considered a milestone during this period (Table 5-4). The
papers were published in Nursing Research a year later. These
publications supported what were previously considered simply
perceptions and conceptions of theoretical nursing from an isolated
number of theorists. Not only did a group of significant people in
nursing get together to discuss theory in nursing, but the official
scientific journal of the field recognized the significance of these
proceedings by publishing them.
Nurses also received confirmation from two philosophers and a nurse
theorist (who had been involved in teaching nurses at Yale for 5 years)
that theories are significant for the practice of nursing, that the
practice of nursing is amenable to theoretical development, and that
nurses are capable of developing theories (Dickoff, James, and
Wiedenbach, 1968). The presentations and the subsequent series of
publications by Dickoff and James (1968) and Dickoff, et al. (1968a,
1968b) influenced the discipline of nursing profoundly, as evidenced by
the classic nature of those publications and by the subsequent
acceleration in publications related to theory. Nursing theory was
defined, goals for theory development were set, and the confirmation of
outsiders (people outside the field of nursing, nonnursing philosophers)
- Parish Nurse
TABLE 5-4 THEORY DEVELOPMENT IN NURSING:A HISTORICAL PERSPECTIVE
|1860||Florence Nightingale addresses the need for research and the educational preparation of nurses.|
|1900–1950||Diploma schools served as major source of nurses—the Flexner Report for Medicine.|
|1952||Nursing Research first published.|
|1955||Establishment of the Special Nurse Research Fellowship Program in the National Institutes of Health, Division of Nursing.|
|1959||D.E. Johnson. The nature of a science of nursing. Nursing Outlook, 7, 292–294.|
|1960||R.N. Schlotfeldt. Reflections on nursing research. American Journal of Nursing. 60(4), 492–494.(The primary task of nursing research is to develop theories that serve as a guide to practice.)|
|1961||Surgeon General’s Consultant Group on Nursing appointed to advise the Surgeon General on nursing needs and to identify the appropriate role of the federal government in assuring adequate nursing services in the nation. This group strongly supported nursing research and recommended a substantial increase in funds.|
|1961||D.E. Johnson. Patterns in professional nursing education. Nursing Outlook, 9, 608. (Nursing science may evolve more easily through the identification of common but major problems of patients that are of direct concern to nursing.)|
|1962||Nurse Scientist Graduate Training Grants Program|
|1963||Nursing Science first published|
|1963||M.E. Rogers. Some comments on the theoretical basis of nursing practice. Nursing Science, 1,11–13. (The theoretical base of nursing practice is nursing science . . . a body of scientific knowledge characterized by descriptive, explanatory, and predictive principles . . . developed through synthesis and resynthesis of selected knowledges from the humanities and the biological, physical, and social sciences. . . . It assumes its own “unique scientific” mix through selection and patterning of these knowledges.)|
|1963||M.E. Rogers. Building a strong educational foundation. American Journal of Nursing, 63(6), 941.(The explanatory and predictive principles of nursing make possible nursing diagnosis and knowledgeable intervention toward predictable goals . . . nursing science is not additive, but creative.)|
|1964||D.E. Johnson. Nursing and health education. International Journal of Nursing Studies, 1, 219.(Nurses must be socialized as scholars and must develop commitment to inquiry and skill in the use of scientific knowledge.) J.S. Berthold. Theoretical and empirical clarification of concepts. Nursing Science, 406–422. M.I. Brown. (Spring). Research in the development of nursing theory. Nursing Research, 13, 109–112. (Assess progress of theory development in nursing and emphasize need for explicit relationship of research to theory.)F.S. Wald and R. C. Leonard. (1964). Toward development of nursing practice theory. Nursing Research, 13(4), 309–313.|
|1965||American Nurses’ Association. Educational preparation for nurse practitioners and assistants to nurses: A position paper.P. Putnam. A conceptual approach to nursing theory. Nursing Science, 430–442.|
|1967||V.S. Cleland. The use of existing theories. Nursing Research, 16(2), 118–121.|
|1967||L.H. Conant. (Spring). A search for resolution of existing problems in nursing. Nursing Research, 16, 115.Symposium on Theory Development in Nursing. (Reported in Nursing Research, 1968, 17(3).)|
|1967–1970||National Commission for the Study of Nursing and Nursing Education, Jerome F. Lysaught, director.|
|1968||First Nurse Scientist Conference on The Nature of Science in Nursing. Sponsored by University of Colorado School of Nursing, Dr. Madeleine Leininger, chair. (Reported in Nursing Research,1969, 18.)First Annual WCHEN Communicating Research Conference|
|1968||J. Dickoff and P. James. A theory of theories: A position paper. Nursing Research, 17(3), 197–206.(Professional disciplines are obligated to go a step further than explanation and prediction in theory construction, to the development of prescriptive theory.)J. Dickoff, P. James, and E. Wiedenbach. Theory in a practice discipline: Part I. Practice oriented theory. Nursing Research, 17(5), 415–435. Idem. theory in a practice discipline: Part II. Practice oriented theory. Nursing Research, 17(6), 545–554.R. Ellis. (1968). Characteristics of significant theories. Nursing Research, 17(3), 217–222.D.E. Johnson. Theory in nursing: Borrowed and unique. Nursing Research, 17(3), 206–209.M. Moore. Nursing: A scientific discipline. Forum, 7(4), 340–347.J.L. Sasmor. Toward developing theory in nursing. Nursing Forum, 7(2), 191–200.|
|1969||G. Mathwig. Nursing science: The theoretical core of nursing knowledge. Image, 3, 9–14, 20–23.R. McKay. Theories, models, and systems for nursing. Nursing Research, 18(5), 393–399.C.M. Norris (Ed.). Proceedings: First, second, and third nursing theory conference. University ofKansas, 1969 and 1970.|
|1971||F. Cleary. A theoretical model: Its potential for adaptation to nursing. Image, 4(1), 14–20.I.M. Harris. Theory building in nursing: A review of the literature. Image, 4(1), 6–10.M. Jacobson. Qualitative data as a potential source of theory in nursing. Image, 4(1), 10–14.J.F. Murphy (Ed.). Theoretical issues in professional nursing. New York: Appleton-Century-Crofts.I. Walker. Toward a clearer understanding of the concept of nursing theory. Nursing Research, 20(5),428–435.|
|1972||M. Newman. Nursing’s theoretical evolution. Nursing Outlook, 20(7), 449–453.NLN Council of Baccalaureate and Higher Degree Programs approved its “Criteria for the Appraisal of Baccalaureate and Higher Degree Programs in Nursing,” including criterion stating that curricula should be based on a conceptual framework.|
|1973||M.E. Hardy. The nature of theories. In M. Hardy (Ed.), Theoretical foundations for nursing. New York:MSS Information Corporation.The Nursing Development Conference Group. (1973). Concept formulation in nursing: Process andproduct. Boston: Little, Brown & Co.|
|1974||M.E. Hardy. Theories: Components, development, evaluation. Nursing Research, 18, 100–107.A. Jacox. Theory construction in nursing: An overview. Nursing Research, 23, 4–13.D.E. Johnson. Development of theory: Requisite for nursing as a primary health profession. Nursing Research, 18, 372–377.|
|1975||Nursing Theories Conference Group. (Formed out of a concern for the need for materials to help students of nursing understand and use nursing theories in nursing practice.)|
|1978||Advances in Nursing Science. S.K. Donaldson and D. Crowley. The Discipline of Nursing. Nursing Outlook, 26(2), 113–120.|
|1979||M.A. Newman. Theory development in nursing. Philadelphia: F. A. Davis.|
|1982||M.J. Kim and D.A. Moritz. Classifications of nursing diagnosis. New York: McGraw-Hill.|
|1983||L.O. Walker and K.C. Avant. Strategies for theory construction in nursing. New York: AppletonCentury-Crofts.J. Fitzpatrick and A. Whall. Conceptual models of nursing: Analysis and application. Bowie, MD: R.J.Brady Co.P.L. Chinn and M.K. Jacobs. Theory and nursing: A systematic approach. St. Louis: C.V. Mosby.H.S. Kim. The nature of theoretical thinking in nursing. New York: Appleton-Century-Crofts.I.W. Clements and F.B. Roberts. Family health: A theoretical approach to nursing care. New York:John Wiley & Sons.P.L. Chinn. Advances in nursing theory development. Rockville, MD: Aspen Systems.|
|1984||J. Fawcett. Analysis and evaluation of conceptual models. Philadelphia: F.A. Davis.|
If you have a religious affiliation, this will allow you to integrate
health and spirituality.
|1900-1950||文凭学校担任护士的主要来源 – Flexner医学报告。|
|1964年||德约翰逊。护理和健康教育。国际护理研究期刊，1,299。（护士必须作为学者社会化，必须发展对科学知识使用的探究和技能的承诺。）JS Berthold。概念的理论和经验澄清。护理科学，406-422。MI布朗。（弹簧）。护理理论发展研究。护理研究，13,109-112。（评估护理理论发展的进展，强调需要明确的理论研究关系。）FS Wald和RC Leonard。（1964年）。走向护理实践理论的发展。护理研究，13（4），309-313。|
|1967- 1970年||国家护理和护理教育研究委员会主任Jerome F. Lysaught。|
|1968年||第一届护理科学性质护士科学家会议。由科罗拉多大学护理学院主持，Madeleine Leininger博士主持。（报告在护理研究，1969年，18 。）第一届年度WCHEN通信研究会议|
|1968年||J. Dickoff和P. James。理论理论：立场文件。护理研究，17（3），197-206。（专业学科有义务比理论构造的解释和预测更进一步，对规定性理论的发展）。迪科夫，P.詹姆斯和E.维登巴赫。实践学科理论：第一部分。实践导向理论。护理研究，17（5），415-435。同上。理论在实践学科：第二部分。实践导向的理论。护理研究，17（6），545-554.R。埃利斯。（1968年）。重要理论的特点。护理研究，17（3），217-222.DE约翰逊。护理理论：借鉴与独特。护理研究，17（3），206-209.M。穆尔。护理：一门科学学科。论坛，7（4），340-347.JL Sasmor。走向理论发展的护理。护理论坛，7（2），191-200。|
|1969年||G. Mathwig。护理科学：护理知识的理论核心。Image，3，9-14，20-23.R。麦凯。护理理论，模型和系统。护理研究，18（5），393-399.CM Norris（编辑）。会议记录：第一，第二和第三届护理理论会议。堪萨斯大学，1969年和1970年。|
|1982年||MJ Kim和DA Moritz。护理诊断的分类。纽约：麦格劳 – 希尔。|
|1983年||LO Walker和KC Avant。护理学理论构建策略。纽约：AppletonCentury-Crofts.J。菲茨帕特里克和A.沃尔。护理概念模型：分析与应用。Bowie博士：RJBrady Co.PL Chinn和MK Jacobs。理论与护理：一种系统的方法。圣路易斯：CV Mosby.HS Kim。护理理论思维的本质。纽约：Appleton-Century-Crofts.IW Clements和FB Roberts。家庭健康：护理的理论方法。纽约：John Wiley＆Sons.PL Chinn。护理理论发展进展。Rockville，MD：Aspen Systems。|
Although the insiders (the nurse theorists) may have charted the course
of action for theory development, the doubts and skepticism about theory
(from the critics who viewed theory as scientific and as evolving from
an empirical, positivistic model) that dominated nursing until then were
somewhat squelched by the presentations and discussions that went on
during that significant meeting in which Dickoff and James (1968, 1971)
and Dickoff, James, and Weidenbach (1968a, 1968b) presented their
metatheory of nursing. The evidence for skepticism is derived from
omission rather than commission. When theories were used during this
period, they were used in conjunction with education and not in practice
(except by New York and Yale Universities faculty and students) or
research. (Refer to the theory literature in Chapter 19 for
documentation of the omission.)
The metatheorists in nursing started their questioning during this
period. Questions of this era were related to what types of theories
nurses should develop rather than to the nature of the substantive
content of those theories. The first metatheorists were Ellis (1968) and
Wiedenbach (Dickoff et al., 1968a, 1968b). Dickoff and James (1968),
philosophers by training, addressed metatheoretical concerns that
focused on types of theories and content of theories. Debates occurred
about whether the theories should be basic or borrowed, pure or applied,
descriptive or prescriptive.
Accomplishments at this stage can be summarized as:
• Nursing is a field amenable to theorizing.
• Nurses can develop theories.
• Practice is a rich area for theory.
• Practice theory should be the goal for theory development in
• Nurses’ highest theory goal should be prescriptive theory, but it is
acceptable to develop descriptive and explanatory theories.
- Staff Nurse
Work regular hours with reasonable pay in a hospital or any healthcare
There was a period, just before the research enterprise in nursing
focused on answering significant questions in the field, when nurse
researchers focused on discussing and writing about research
methodology. A parallel exists in the area of theory. The period from
1966 to 1970 resulted in a beginning focus on theory development, which
was followed by attempts at identifying the structural components of
theory (see Table 5-4). Metatheorists dominated this period. The
emphasis was on articulating, defining, and explicating theory
components and on the processes inherent in theory analysis and
critique. Nurse theorists were no longer questioning whether nursing
needed a theory or whether or not theory could be developed in nursing;
questions of this period focused on what is meant by theory (Ellis,
1968, 1971; Walker, 1971), on what are the major components of theory
(Hardy, 1974; Jacox, 1974), and on ways to analyze and critique theories
(Duffey and Muhlenkamp, 1974). Education of nurses in basic, natural,
and social sciences through the federally supported nurse–scientist
programs produced a cadre of nurses who shared a common goal: the
establishment of the unique knowledge base of nursing. Discussions of
what constituted theory and the identification of theory syntax seemed
to be the means to achieve that goal.
- Nurse Midwife
Just before the close of this period, a milestone was achieved. Just as
the ANA acknowledged the significance of theory development during the
previous period, the National League for Nursing (NLN) not only
acknowledged theory but also made theory-based curriculum a requirement
for accreditation. Schools of nursing were expected to select, develop,
and implement a conceptual framework for their curricula. This
requirement for accreditation was both a moving force and a major
barrier to theory development. To use theory for curriculum development
further heightened awareness of academic nursing to the significance of
theory and to the available nursing theories. However, this requirement
diverted the goal of developing theories for practice (those theories
that would answer significant questions related to practice) to the goal
of using theory for education. Nevertheless, this milestone increased
the use of theory and discussions about theory and prompted more writing
about the syntax of theory to help academicians and students understand
and use theories in curriculum and teaching. The limited number of
journals that acknowledge and promote theoretical nursing, the focus on
promoting the publication of empirical research findings, and the
growing financial difficulties of some journals were barriers to written
exchanges on theory and theorizing.
Help deliver babies. You will also be involved in providing ante- and
1976–1980—A Time to Reflect
- Insurance Firm Nurse
一九八〇-壹玖柒玖年 – 反映时间
Nurse theorists were invited to participate in presentations,
discussions, and debates in conferences sponsored by nurse educators,
marking a significant milestone in the progress of theoretical nursing.
A national conference devoted to nursing theory and the formation of the
Nursing Theory Think Tank in 1978 further supported the direction of the
profession toward the utilization of existing theory and the development
of further theory to describe and explain nursing phenomena, to predict
relationships, and to guide nursing care (Preview, 1978). This was the
time for nurse academicians, who had used nursing theories as guiding
frameworks for curricula, to consider putting theory to other uses,
particularly in practice.
The inauguration of the journal, Advances in Nursing Science, with its
focus on “the full range of activities involved in the development of
science,” including “theory construction, concept, and analysis” and the
application of theory, was another significant milestone during this
period (Chinn, 1978) (see Table 5-4). The focus of the journal on theory
and theory development added more support to the significance of
theoretical nursing and simultaneously gave nurses who were interested
in theory the necessary medium in which to present and discuss their
ideas. It allowed for the questioning and debate that is necessary for
the development of theoretical bases in any discipline.
This period was characterized by questioning whether nursing’s progress
would benefit from the adoption of a single paradigm and a single theory
of truth (Carper, 1978; Silva, 1977). More sophisticated debates about
what types of theory nursing needs (Beckstrand, 1978a, 1978b, 1980) and
about issues in theory (Crawford, Dufault, and Rudy, 1979) appeared in
nursing literature. A more solid commitment to the development of theory
emerged, combined with a specific direction to nurses’ efforts in theory
development (Donaldson and Crowley, 1978; Hardy, 1978). The links
between theory and research were considered and discussed (Batey, 1977;
Fawcett and Downs, 1986), the path was charted for bridging the
theory–research gaps between theory and practice (Barnum, 1990), theory
and philosophy were examined (Silva, 1977), and the role of each in the
development of nursing knowledge was clarified (see Fig. 5-1). Domain
concepts were beginning to be identified, and their acceptance was
demonstrated in the next period.
Insurance companies often need nurses to assess claims.
1981–1985—Nursing Theories’ Revival: Emergence of the Domain Concepts
- Keep Studying Towards a Bachelor’s, Master’s or Doctorate Degree
1982年至1981年 – 护理理论的苏醒：域概念的产出
In this period, theory began to be questioned less and pluralism debated
less. This period was characterized by an acceptance of the significance
of theory for nursing and, furthermore, by the inevitability of the need
for the development of nursing theory. Doctoral programs in nursing
incorporated theory into their curricula and considered it a core
content area, ranking it at the top of all other core content (Beare,
Gray, and Ptak, 1981). This period was also characterized by enlightened
international interest in theoretical nursing as manifested in
conferences in Sweden and demand for consultations on theory teaching in
Thailand, Korea, and Egypt, among other countries.
在这几个时代，理论开始被困惑得越来越少，多元论辩论也越来越少。这一时半刻期的表征是承受护理理论的关键，并且还有须要开销护理理论。护医学学士课程将答辩纳入其课程并将其身为宗旨内容领域，将其列为全体任何大旨内容（Beare，格雷和Ptak，1981）的顶部。那权且期的特色还反映在国际上对理论护理的志趣，那展现在瑞典王国的集会上，并供给在泰王国，大韩民国和阿拉伯埃及共和国（The Arab Republic of Egypt）（The Arab Republic of Egypt）等国家进行理论教学磋商。
A review of theory literature during this period reveals the lack of
debate on whether to use theory–practice versus basic theory or borrowed
versus nursing theory. Instead, there appeared to be more writing on the
examination of nursing theories in relation to different research and
practice problems and on comparisons between the different
conceptualizations (Jacobson, 1984; Spangler and Spangler, 1983).
Questions of this period included:
• What have we learned from theory?
• How can we use theory?
The second question was one that clinicians began to ask and for which
there have been many useful dialogues.
The newly emerging syntax was used to analyze existing theories
(Fawcett, 1984; Fitzpatrick and Whall, 1983). In addition, existing
theories came to be thought of as the means to develop unique nursing
knowledge. Concepts central to nursing were identified, and existing
theory, the source of the identified concepts, was in turn re-examined
in terms of further development and refinement (Crawford, 1982; Reeder,
This period was characterized by the nursing theory advocates who
pleaded for the use of a nursing perspective in general or for the
specific utilization of nursing theory (Adam, 1983; Dickson and
Lee-Villasenor, 1982). (See Advances in Nursing Science, Journal of
Nursing Administration, and American Journal of Nursing for examples of
the American advocates and Journal of Advanced Nursing for examples of
international advocates.) Another group also emerged during this period:
the theory synthesizers. The difference between the advocates and the
synthesizers was in the level of the scope of analysis. The advocates
promoted nursing theory and demonstrated its use in research projects or
in a limited practice arena. The synthesizers went beyond that limited
use to describe and analyze how nursing theory had influenced nursing
practice, education, research, and administration. The synthesizers are
exemplified by, but not limited to, Fitzpatrick and Whall (1983, 1996)
and Fawcett (1984, 1995). The Rogerian First National Conference (1983)
and subsequent ones, in which theoreticians, practitioners, and
researchers discussed the utility of Rogers’ theory from different
perspectives, is a different example of an effective synthesis of
different uses of a theory. The planners of this conference belong to
the group of theory synthesizers.
A few theory synthesizers graduated from New York University in the
mid-1970s. One thing that cannot be ignored, is the influence of New
York University nursing program on advancing theoretical nursing. This
is made evident by a review of the titles of doctoral dissertations in
nursing from New York University from 1941 to 1983, which provide a
clear example of how a school of nursing using a coherent theoretical
framework can drive a coherent research agenda. Most of the titles of
the dissertations indicate a nursing perspective, and there appears to
have been an attempt at cumulative knowledge development. How and in
what ways such a pattern may have influenced and may continue to
influence theory development is an area worth further investigation and
analysis, however, we do see a Rogerian conference every once in a while
that brings many nurse scholars together to speak the same theory
language and to show their research. The outcome of such gatherings on
discovery, integration, and innovation of nursing knowledge is yet to be
This period was characterized by an acceptance of theory as a tool that
emanates from significant practice problems and that can be used to
guide practice and research. This period was also characterized by a
greater clarity in the relationship between theory and research than
between theory and practice.
One remaining confusion during this period was related to semantics.
Conceptual models were referred to as conceptual frameworks, theories,
metatheories, paradigms, and metaparadigms and, when differentiated,
boundaries were not totally clear and properties not entirely distinct.
(See discussion about Rogers’ theory in chapter 13.)
Nurses are committed to the furthering of the professional education.
From being a nurse assistant, you can move on to license practical
1986–1990—From Metatheory to Concept Development
to an associate’s degree in nursing, to a bachelor’s degree, to a
master’s degree and finally a Ph.D. in nursing.
Three characteristics of this milestone were epistemological debates,
ontological analyses, and an increase in concept development and
analyses. One other characteristic of this period was the acknowledgment
of the gap between theory and practice. The epistemological debates
included questions related to describing alternative approaches to
knowledge development, such as the use of phenomenology, critical
theory, and feminist or empiricist methodologies, and how to connect the
dialectal approach to theory and practice (e.g., Allen, 1985; Allen et
al., 1986; Hagell, 1989; Leonard, 1989). Although the debates were
focused on knowledge development in general rather than on theoretical
development of the discipline, these debates were related as well to the
development of theoretical nursing. Concept development emerged as a
potential link between the theoretical knowing and the practical doing.
Allen et al。 壹玖捌柒; Hagell，一九八六;
Effective analyses were those that focused on ontological beliefs
related to central nursing concepts, for example, environment
(Chopoorian, 1986; Stevens, 1989), and health (Allen, 1985, 1986;
Benner, 1984). These analyses added substantially to a more contextual
approach to understanding each concept. These analyses also raised the
awareness and the consciousness of nurses to the necessity of using
frameworks that allow for an integrative, holistic, and contextual
description of nursing phenomena, phenomena that go beyond the
individual clients. Such frameworks, these authors demonstrated,
maintained the integrity of the basic ontological beliefs that have
historically guided nursing practice, for example, holism, integrated
responses, and relationship with environment.
The third property of this milestone was an increase in writings related
to concept development. These developments were different from earlier
theory developments that included answers to such general questions as
“What is nursing?” These analyses were more practice oriented, were
integrative, and represented early attempts in the development of single
domain theories. This was also the period in which a plea for substance
was made (Chinn, 1987; Downs, 1988; Meleis, 1987; Woods, 1987). These
authors echoed the sentiment of other discipline members by urging
discourse that was more focused on substantive issues that were
confronting health care recipients.
Process debates became more a potential force for theory development
when and if they were grounded in substantive disciplinary content.
Therefore, instead of debating whether critical theory or feminist
theories were more appropriate as a philosophical base for the
discipline, one may argue whether it was more effective to view
environment or comfort from either or both perspectives. Such
substantive debates then would add to or revise parameters and
dimensions of that area of knowledge.
- Work Abroad
1991–1995—Middle-Range and the Beginning of Situation-Specific Theorizing
The nursing degree that you obtain in this country can be transferred to
a license to practice in most other countries.
One significant milestone that marks the considerable progress in
knowledge development in nursing is manifested in the numerous
middle-range theories that evolved during this period. Some of these
were labeled as theories (e.g., Younger’s Theory of Mastery  or
Mishel’s Theory of Uncertainty ). Others were considered in the
process of becoming theories. (See Funk, Tornquist, Champage, Copp, and
Wiese  for discussions about key aspects of recovery and
Hagerty, Lynch-Sauer, Patusky, and Bouwsema  for their emerging
theory of human relatedness.) Middle-range theories focus on specific
nursing phenomena that reflect and emerge from nursing practice and
focus on clinical process (Meleis, 1987). They provide a conceptual
focus and a mental image that reflect the discipline’s values, but they
do not provide prescriptions for practice or specific practice
guidelines (Chinn, 1994).
Situation-specific theories may be emerging as another milestone,
although they were better defined in later years. They are theories that
are more clinically specific, theories that reflect a particular
context, and may include blueprints for action. They are less abstract
than middle-range theories but far more abstract than individual nurses’
frameworks for practice designed for a specific situation (Meleis, 1997;
Im and Meleis, 1999; Im, 2005). These situation-specific theories may
emerge from synthesizing and integrating research findings and clinical
exemplars about a specific situation or population with the intent of
giving a framework or blueprint to understand the particular situation
of a group of clients. They are theories that are developed to answer a
set of coherent questions about situations that are limited in scope and
limited in focus. For example, a conceptualization of patterns of
responses to health–illness transitions of Middle Eastern immigrants
could be developed from the results of research studies, the clinical
exemplars, and the experience of nurses in their care of this population
(Meleis, Isenberg, Koerner, Lacey, and Stern, 1995). An example is work
that has focused on Middle Eastern immigrants (Afghans, Iranians,
Egyptians, and Arabs), supported by similar work on these populations in
their native countries, which helps illuminate patterns of behavior and
responses before immigration and helps in providing a historical and
sociocultural context for the responses of immigrants in their new
Im and Meleis，一九九六;
Im，二〇〇六）。这几个针对具体情状的争鸣恐怕现身于综合和整合有关特定情景或人群的钻研结果和医疗样本，以期提供框架或蓝图来掌握一组客户的特定情景。它们是为了酬答有关限制有限且主要有限的景观的一密密麻麻连贯难题而制定的说理。例如，能够从商量结果，临床样本以及医护人员对这一个人群的看护经验中提升出中东移民健康疾病转变反应情势的定义（Meleis，Isenberg，Koerner，莱西和斯特恩，一九九三年）。3个例子是注重于中东移民（阿富汗人，伊朗人，阿拉伯埃及共和国（The Arab Republic of Egypt）人和阿拉伯人）的办事，那么些干活儿获得那么些人在笔者国的类似工作的帮助，那促进申明移民前的一坐一起和反馈形式，并有助于提供历史以及移民在新国家的反应的社会文化背景。能够从钻探结果，临床样本以及护师在这么些人群中的经历（Meleis，Isenberg，Koerner，Lacey等人）中升华出中东移民对健康疾病转变反应格局的定义。斯特恩，一九九二年）。几个例证是着重于中东移民（阿富汗人，伊朗人，阿拉伯埃及共和国（The Arab Republic of Egypt）（The Arab Republic of Egypt）人和阿拉伯人）的工作，那一个干活儿赢得这么些人在作者国的接近工作的协助，那促进申明移民前的行事和反应格局，并推进提供历史以及移民在新国家的感应的社会文化背景。能够从研讨结果，临床样本以及医护人员在那1个人群中的经历（Meleis，Isenberg，Koerner，Lacey等人）中进步出中东移民对健康疾病转变反应格局的定义。斯特恩，1993年）。二个事例是重视于中东移民（阿富汗人，伊朗人，埃及（Egypt）人和阿拉伯人）的劳作，那些工作取得这几个人在作者国的接近工作的支撑，那有助于表明移民前的行为和反应方式，并有助于提供历史以及移民在新江山的反响的社会文化背景。以及护理职员照顾那么些人群的经历（Meleis，Isenberg，Koerner，Lacey和Stern，1991）。3个例子是珍视于中东移民（阿富汗人，伊朗人，阿拉伯埃及共和国（The Arab Republic of Egypt）人和阿拉伯人）的干活，那一个干活儿赢得那些人在本国的好像工作的帮忙，这有助于注脚移民前的作为和影响方式，并促进提供历史以及移民在新江山的反射的社会文化背景。以及护理职员照顾这一个人群的经验（Meleis，Isenberg，Koerner，Lacey和Stern，一九九一）。2个例证是注重于中东移民（阿富汗人，伊朗人，埃及人和阿拉伯人）的工作，这几个干活儿赢得这个人在笔者国的近乎工作的援助，那促进表明移民前的行事和反应情势，并推进提供历史以及移民在新国家的感应的社会文化背景。
- Prison Nurse
1996–2000—Evidence Means Research, Not Theory
This is incredibly hard work and not for the faint of heart.
一九九六年至3000年 – 证据意味着钻探，而不是理论
Evidence-based practice evolved after much discourse in the literature
from evidence-based practice to evidence-based nursing. During this
milestone, the focus of the literature written about the discipline was
on identifying the similarities and differences between utilizing models
of care with best evidence, translating research into practice, and
using applied research (French, 1999). To determine evidence,
methodologies were discussed for defining the quality of individual
studies, the methods for integrating study findings, and criteria for
judging integrative findings and what constitutes evidence that could be
used in the literature (Goode, 2000; McKee, Britton, Black, McPherson,
Sanderson, Bain, 1999). Several properties distinguish this milestone.
First, most of the dialogues were initially based on arguments from the
medical field, which reduced “the evidence” to biomedical, empirical,
and positivist variables and criteria (Lohr and Carey, 1999). A second
property is a critical dialogue about eclectic views of evidence that
may incorporate components that are more congruent with nursing science
and emanate from how nursing knowledge and knowing have been defined.
This critical dialogue includes discussions on widening the meaning of
evidence to make it more pluralistic, to incorporate humanistic
experiences as well as personal experiences as evidence of models of
care to be used (Clarke, 1999). However, the criteria for judging
evidence from within this framework have not been explored, and no
definitive ideas been reached. A third property of this milestone is a
focus on best strategies to implement the best evidence in health care
institutions. Different models and approaches to utilizations are
defined and explored utilizing teaching-learning theories as well as
organizational change theories (Grol and Grimshaw, 1999).
The Cochrane Database of Systematic Review plays a major role in
providing frameworks for rigorous reviews of data-based evidence, for
integrating reviews for determining best supported evidence, and for
developing and implementing best organizational infrastructures to
implement and promote best practices (Foxcroft, Cole, Fullbrook,
Johnston, Stevens, 2001).
The fourth property of this milestone is its global appeal and
utilization of evidence-based concepts in different parts of the world.
Nurses, researchers, and clinicians in different regions engaged in
dialogues about integrative reviews and accessibility of research-based
knowledge for clinicians. (See Thompson, McCaughan, Cullum, Shelton,
Mullhall, and Thompson 2001.)
The last property of this milestone is the absence of a robust
theoretical dialogue about the place of theory or philosophy in driving
the nature of evidence, the premises supporting pluralism in methods,
the framework for interpretation, and the principles behind the
selection of outcomes. Shifting from an evidence–based discourse about
practice to an inquiry–based dialogue could bring back a critical
theoretical discourse to nursing practice. (Doane and Varcoe, 2008;
Holmes, Murray, Perron, and Rail, 2006; Holmes, Roy, and Perron, 2008.)
- District Nurse
2001–2005—Diversity in Thought: Linking Theory and Practice
Take responsibility over health delivery and health promotion in a
二〇〇二-二〇〇七 – 思想的种种性：联系理论与执行
A focus on diversity is a hallmark of this milestone in the ongoing
journey toward the theoretical development of the discipline. As the
agents of scholarship become diverse in identity, ethnicity, and
heritage, and as they become more comfortable with their differences,
their varices began to appear in the literature reflecting their
different values, beliefs, and goals. Among the examples of the
diversity in thought and in theories are those by nurses from different
countries. Theories were developed by nurses from Finland and Sweden and
dialogues about more authentic theoretical formulations reflecting the
realities of different countries gained more popularity (Salas, 2005).
Similarly, during this milestone, diversity of views on developing
theories from a number of grounded theory research projects as well as
through integrating different theories emerged with more robust
dialogues than ever occurred before. Olshansky (2003), for example,
conducted six grounded theory projects and developed a theory of
“identity as infertile” and combined this theory with Miller’s (1991)
theory of “relational cultural” theory to explain potential
vulnerability to depression of women whose identity is established as
“infertile women.” Both theories were integrated and provide a stronger
explanation for identity shifts that occur post pregnancy for these
women. The theory explains that although the women identified as
“infertile women” were able to become pregnant, it is very difficult for
them to perceive themselves as pregnant. This difficulty in identity is
an obstacle to forming relationships with other pregnant women.
Diversity as a hallmark of this milestone was manifested in a variety of
health–illness situations requiring a careful analysis of the factors
that create diversity. Among these are age, race, ethnicity, country of
heritage, gender, and sexual orientation. This awareness led theorists
and researchers to critique prevailing approaches and assumptions and
propose alternative and more contextually situated theoretical thoughts.
Examples are Berman (2003) on the myths surrounding the power of
children, Im and Meleis (2001) in their proposal for developing
gender-sensitive theories that focus on health and illness, and Anderson
et al. (2003) who rewrote a conceptualization of cultural safety within
postcolonial and postnationalist feminist theories.
Georges (2003) defined the prominent discourses that reflect this
milestone. Her thesis is that there are two discourses in nursing that
are shaping epistemic diversity in contemporary nursing. These are the
discourses on science that are more broad and enlightened and a
postmodernism discourse on marginalization. Both of these discourses
provide a critique of dominant understanding and agreements on
scholarship allowing freedom to represent the different perspectives on
knowledge development. Epistemic diversity in an era that honors
diversity in its broadest sense may free members of the discipline to be
inclusive and may transform the discipline to make it truly reflective
of the people nurses need to serve. Such diversity would also allow
critique of power inequity as well as existing networks that support
such inequities and transform social practices that tend to
institutionalize dominant approaches to theory (Gustafson, 2005). Once
again Hall (2003) reminds us in a powerful autobiographical note from
her illness experience about how medicalization of illness experiences
and about how the stronghold of the biomedical model are not in the best
interest of patients and their families. Georges (2005) uses a critical
feminist perspective to uncover her journey in rewriting her own
identity as a clinician-theorist-academician-researcher. She provides a
robust philosophical argument for the linking of theory and practice
within the political and social context of the first decade of the 21st
century. Such linking could occur through teaching theory using
strategies that help students to develop their authentic voices about
their practice. Properties of this milestone are critique of status quo,
reconceptualization that is situated and contexted, and attention to
analysis that honors diversity in cultures, ethnic backgrounds,
heritage, language proficiency, gender, and sexual orientation.
- 理论家 –
- Learning Disabilities Nurse
2006–2010––Nurses Empowered: Evidence and Technology as Resources
Work with children and adults who have various levels of learning
二〇〇五-二零零六年 – 护师授权：证据和技能作为能源
The post positivism age, the age of interdisciplinarity, and the age of
postcolonial feminism are marked by a major milestone in nursing, the
empowerment of nurses and the nursing profession in affecting nursing
care. Call me an optimist but let me give some reasons why I believe
that such a turning point is happening. Many addressed the
decolonization of nursing from the biomedical model, from the
patriarchal hierarchy, and from nonnursing institutional regulatory
mechanisms (Holmes and Gastaldo, 2004; Holmes, Roy and Perron, 2008).
Separating nursing from these paradigms is in itself liberating;
however, more compelling indicators of this liberation is the use of
different paradigms to guide theory development and research, as is
evident in the nursing literature produced at the end of the first
decade of the 20th century (see examples in Advances in Nursing Science,
Nursing Inquiry, and Nursing Scholarship). The prominence of nurses in
prime-time television and their depiction as forceful independent
clinicians are other examples of the changing image and visibility of
nurses. The media finds that nursing stories are worth printing, which
is an indication that reporters are recognizing that the public is
interested in these valuable experiences. Improving compensation, the
availability of diverse employment options, and the selection of nurses
to staff independent mini-clinics are all indications of the shifting
power structures in health care systems.
后实证主义时代，跨学科时期和后殖民女权主义年代的特征是医生和护师的八个主要里程碑，护士和护理专业人士在潜移默化护理方面的权限。称自个儿为乐观主义者，但让小编付出一些原因，为啥本身认为那种转折点正在爆发。许多切磋从生物经济学形式，男权制等级和非体贴制度管理机制（Holmesand Gastaldo，二零零零; 霍姆斯，罗伊 and
The health care reform discourse surrounding the moral obligation of the
government to provide safe, quality, and equitable health care for the
U.S. population includes an acknowledgment that the nurse’s role is
central to the health care reform. The inclusion in the discourse of the
need for increasing the number of nurses in the workforce, as well as
ensuring the utilization of their full capacity, is in itself empowering
for nurses. Therefore, the increasing dialogue about primary health
care, patient-centered care, and collaborative partnerships between
physicians and nurses, whether in conferences or in Institute of
Medicine publications, honors and acknowledges the value of nursing
knowledge and nursing care (Frenk et al., 2010; IOM, 2011). These in my
view, are indicators of a milestone: Nurses are empowered.
There are other indications of nurses’ power to make a difference.
Entering hospitals and observing nurses handling patient tracking
systems, health care records, automated medication carts, and remote
monitoring systems raises many questions. In particular, how do nurses
integrate theoretical frameworks with technological development and the
increasing reliance on communication through computers? How do nurses
maintain their focus on the goals of nursing—patient-centered goals of
health promotion, caring, comforting, decreasing suffering, and
promoting self-care and a sense of well-being—while being attentive to
the new demands imposed by the information and monitoring technology
characteristic of hospitals and home care in the 21st century?
The juxtaposition of caring for the individual and her family within the
environment of innovation and complexity of information and technology
requires the development of new frameworks and models of care. This
stage of the discipline’s development is enriched by forging different
and new partnerships between such disciplines as engineering, pharmacy,
and the information sciences.
An aging population, as well as an increase in the numbers of people
aging at home and of families living and caring for chronically ill
individuals through the lifespan, requires the development and use of
theories that are more specific to the particular needs of a more
defined population. Requirements for compensation and reimbursement by
insurance companies and the consequences of massive health care reform
frame patterns in advancing knowledge during this stage. Research
evidence is vital for credibility, safety in providing care, and
reimbursement for services. And nurses are taking full advantage of the
evidence and the technology.
- Occupational Health Nurse
This chapter presented significant historical themes that are related to
an interest in theoretical nursing. Progress and development in
theoretical nursing was defined in terms of stages and milestones. A
view of historical development offers a significant perspective on which
current and future theoretical thinking can be built. Analysis of
present development is deficient without tracing these historical
Work in large companies or in hospitals. You will ensure people can work
in a mentally and
3.您干吗觉得 20世纪五 六十时期哥伦比亚（República de Colombia）和瑞典王国皇家理经济高学校护士理高校的环境和知识对
physically safe manner.
The first part of this chapter is based on A.I. Meleis (1983). The
evolving nursing scholarliness. In P.L. Chinn (Ed.),Advances in nursing
theory development, pp. 19–34. Reprinted with permission of Aspen
- Pediatric Nurse
Work with children between the ages of 0 and 19.
- Pharmaceutical Nurse
This is an interesting field for nurses who no longer wish to work
directly with patients. Working for
pharmaceutical companies is a very interesting alternative.
- Public Health Nurse
This is reserved for those with an MSN degree.
- Plasma or Blood Bank Nurse
You will take plasma and blood from donors, encourage others to donate,
test blood and more.
- Army Nurse
The army is always looking for nurses, particularly since we are still
involved in a number of different conflicts.
- Home Health Nurse
You get to build a long lasting relationship with your patients, whom
you will see in their homes.
- Hospice Nurse
Hospice nursing is hard, as you will be dealing with people who are
dying. Your role will be to
allow them to do so comfortably and in a dignified manner,
and supported by their loved ones.
- Surgery Nurse
Assist surgeons during procedures, as well as look after patients during
- Critical Care Nurse
Critical care nursing is one of the most fast-paced jobs.
- Emergency Room Nurse
You will never know what sort of cases you are going to get. Expect
long, unsociable hours
in a fast-paced environment.
- Managed Care Nurse
For those with chronic or terminal conditions, who require specialized
care at home and/or in health
care settings for the rest of their lives.
- Dermatological Nurse
This allows you to treat skin conditions.
- Plastic Surgery Nurse
Plastic surgery is often done for cosmetic reasons, although it is also
done for people with
disfigurements and scars.
- Burns Unit Nurse
Work with people who have suffered burns, including fire burns and acid
- Oncology Nurse
Work with cancer patients.
- Rehabilitation Center Nurse
Help people who have had an accident or other physical issue to regain
as much mobility as possible.
- Missionary Nurse
Spread the word of God throughout the world, while at the same time
deliver health care
to impoverished countries.
- Charity Nurse
Numerous charities employ nurses, many of which provide disaster relief.
- Traveling Nurse
Traveling nurses are sent from one place to the next for short durations
of time to cover in hospitals and
care settings with an acute shortage of nurses.
- Inspire Others
Be an inspiration to other people by showing your care and dedication to
- Rural Nurse
Many nurses work specifically in areas with poor access to health care.
- Outpatient Care Nurse
Outpatient care is one of the easier sides of nursing, as it allows you
to treat patients ad hoc and then send them back home.
- Nurse Anesthetist
Assist surgeons and anesthetists during procedures.
- Health Administration Nurse
Health administration allows you to work in a range of healthcare
fields, where you can influence policy development.
- Clinical Nurse Specialist
A CNS has a specialization in a very targeted area of nursing practice,
such as women’s health.
- Clinical Nurse Leader
This is the newest nursing role, whereby your goal will be to improve
safety outcomes and care quality for patients.
- Family Nurse Practitioner
Work with everybody in the family, seeing them as a full unit rather
than groups of individuals.
- Health Visitor
Health visitors mainly focus on working with women who have had babies
in the past two years, ensuring the development of the babies and
infants is as expected.
Paramedics provide acute emergency care. It is a stressful job with
long, unsociable hours, but it is also incredibly rewarding.
- Licensed Nursing Facility Administrator
Handle the administration in facilities like nursing homes. Generally,
you will have very little direct contact with patients.
- Health Coach
Teach others how to obtain and maintain optimum health.
- Nutrition and Fitness Nurse
Work directly with individuals who hire you on a personal level.
Although perhaps far removed from nursing, many nurses can become a
nanny as it allows them to work on a one-one-one basis with a young
- Acute Care Nurse
Adult-gerontology acute care is a very popular field of work, where you
take care of adult patients with various problems as and when they
- Community Nurse
Represent an entire community of people, usually underserved ones.
- Obtain Further Non-nursing Related Education, Such as Counseling,
Social Work or Law
Many nurses who hold a bachelor’s degree go on to achieve another
bachelor’s or a master’s degree in an non-nursing field.
- Health Programs Nurse
The development of health programs allows you to make a true difference
across the world, improving outcomes while reducing costs at the same
- Health Representative at Conferences and Media
Whenever decisions are made in the field of healthcare, they have to be
presented to the rest of the world and questions have to be answered
- NGO Nurse
Non-Government Organizations (NGOs) often help to improve the world on a
very personal level and offer very rewarding career options.
- Procurement Nurse
You will purchase the equipment needed for nurses to do their jobs
properly, always trying to find the lowest price and highest quality.
- Nursing Students Mentor
New students require mentors to look up to. This is something anyone
with a nursing degree should aspire to be.
- Grant Writing Nurse
Grant writing means you are directly responsible for applying for
funding in the hopes of improving health care delivery.
- Health Facilities Survey Nurse
This will allow you to ensure health facilities are fit and will
actually improve the health of the people they serve.
- Commissioner for Health Products and Programs
More and more services are now outsourced and by working in
commissioning. You will ensure that the right services are used.
- Quality Assurance Nurse(品质担保/维护护师)
Quality improvement can be achieved in all areas of nursing.
- Public Health Research Nurse
See whether certain initiatives have actually improved the health
outcomes of the population and why.
- Disease Prevention Nurse
Help stop the spread of infectious diseases.
- Epidemics Research Nurse
There is a significant worry that we are on the brink of a new epidemic
or pandemic, like Ebola. Nurses are needed to research the various new
come up with cures and techniques to prevent spreading.
- Asylum Nurse
Asylum seekers often have highly complex health needs, including
- Nurse for At Risk Populations
Certain populations are classed as “at risk,” such as veterans and the
homeless. They often require specialized health care.
- Nurse Lobbyist
You will speak to Congressmen and Senators in the hope of encouraging
certain health care ideas to be legislated and receive funding.
- Federal Health Care Nurse
Work on federal health care development programs to affect outcomes for
- Continuous Professional Education Coordination
All nurses are dedicated to their continuous professional education.
Coordinating this and keeping on records on further education is an
interesting and varied role.
- Bioterrorism Research Nurse
Bioterrorism requires extensive knowledge on development and behavior of
- Medical Journalist
Investigate and report on healthcare issues around the globe.
- Disaster Management and Relief Nurse
Provide health care to affected populations after a disaster.
- Toxicology Nurse
Having an understanding of poisons and their effects on humans is hugely
- Environmental Health Nurse
Environmental health, how our behavior affects the planet and how the
planet affects our health are very important issues to look at for a
- Hazardous Waste Nurse
Hazardous waste could have devastating consequences on the health of
- Industrial Nurse
This is closely related to occupational health, although this type of
nurse will look more at overall risk and hazard prevention.
- Forensic Nurse
Forensic nursing is often required after crimes have been committed.
- Study Programs Development Nurse
Develop programs for the next nursing generation.
- Vaccine Research Nurse
Ensure that people are immunized against various illnesses, and review
their effectiveness and possible side effects.
- Ambulatory Care Nurse
With ambulatory care, cases that would usually require stay in hospital
are resolved on an outpatient basis.
- Flight or Transport Nurse
Help treat people who have to be expatriated due to illness or injury.
- Certified Nurse Assistant
Support the workload of other nurses and ensure they can perform their
- Cardiac Catheterization Lab Nurse
Help to insert catheters into aortas to diagnose heart conditions.
- HIV/AIDS Nurse
HIV/AIDS continues to be a significant health issue that requires
research, development and care.
- Genetics Nurse
You will research genes and their effects.
- Holistic Nurse
Holistic nurses believe everything is interconnected and needs to be
addressed in order to provide great health care.
- Mind, Body and Spirit Nurse
Very similar to holistic nursing but you often use Eastern and Oriental
care techniques, including Reiki and acupuncture.
- Legal Nurse Consultant
Provide consultation on legal matters within the health care field.
- NICU Nurse
Work with very sick and premature babies in the Neonatal Intensive Care
- Peri-Anesthesia Nurse
Help patients who are coming out of anesthesia.
- Peri-Operative Nurse
Look after patients who are recovering from surgery.
- Radiology Nurse
Work extensively with cancer patients.
- Registered Nurse
Most of those who have a nursing degree simply begin work as an RN
before choosing an area of specialization.
- Transplant Nurse
Work with people who require organ transplants.
- Wound Ostomy Continence Nursing
This is a highly specialized field of nursing where you deal with
patients who have problems with wounds, ostomy and continence. Only some
4,000 nurses worldwide have specialized in this field to date.
- Focus on Improved Health Care Outcomes
DATA analysis and research, must be MSN.
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