History and Evolution of Nursing

Florence Nightingale

Mother of modern nursing

Florence Nightingale

Laid the foundation (pioneer)

Florence Nightingale

comes from an affluent family during the Victorian era of England

1800s

The time when Nightingale saw purpose in serving others/volunteered to be a war nurse during the Crimean war

Florence Nightingale

Organized and cared for the wounded soldiers in Scutari during the Crimean war Florence Nightingale

Core focus

caring for the person and their environment to put the patient in the best condition for nature to heal them

100 year gap

Despite Nightingale's vision, nursing remained a vocation for the next century [Evolution of Nursing]

100 year gap

Practice relied on apprenticeship, models, traditions, and hospital manuals rather than science [Evolution of Nursing]

100 year gap

Need to development apart from medical (mid 20th century) nursing received significant development [Evolution of Nursing]

100 year gap

Before it was more compliance based, it evolved into profession [Evolution of Nursing]

The Shift to a Profession

Nursing leaders began actively developing a specialized body of nursing knowledge [Evolution of Nursing]

The Shift to a Profession

Marked the crucial transition from a tradition trade into a recognized academic discipline and profession [Evolution of Nursing]

The Shift to a Profession

Nursing flourished and developed in USA for nursing schools [Evolution of Nursing]

Curriculum Era

1900s-1940s [Evolution of Nursing]

Curriculum Era

Major question: What content should nurses study [Evolution of Nursing]

Curriculum Era

course selection and content for nursing programs (body of knowledge at arriving a standardized curriculum) [Evolution of Nursing]

Curriculum Era

Milestones: standardized curriculum published for diploma programs by the mid

Curriculum Era

1. Nursing before trained in hospitals

2. Emergence of the idea to move

3. Education into college and universities

[Evolution of Nursing]

Research Era

1950s-1970s [Evolution of Nursing]

Research Era

Major question: What is the focus for nursing research? [Evolution of Nursing]

Research Era

The shift: Embracing higher education and the scientific age

[Evolution of Nursing]

Research Era

1. Research courses were added to graduate nursing programs

2. Review of nursing research in the 1970s

[Evolution of Nursing]

Research Era

• Seek new knowledge, as continuous information (innovate)

• Research improve the existing body of knowledge

• To create new theoretical frameworks (systematized body of knowledge)

[Evolution of Nursing]

Graduate Education Era

1960s-1970s [Evolution of Nursing]

Graduate Education Era

Major question: What knowledge is needed for the practice of nursing? [Evolution of Nursing]

Graduate Education Era

Emphasis: Emerged alongside the research era to create clinicals specialists [Evolution of Nursing]

Graduate Education Era

Baccalaureate degree gained wide acceptance; nursing is recognized as an academic discipline (getting knowledge from research) [Evolution of Nursing]

1960s-1970s debate

Notion that should nursing knowledge be offered discipline based or nursing based

Nursing practice must be based on nursing

Outcome of the 1960s-1970s debate

Theory Era

1980-1990s

Theory Era

Major Question: How do these frameworks guide research practice? [Evolution of Nursing]

Theory Era

Emphasis: Marked by explosive proliferation of nursing doctoral programs (knowledge was synthesized and were conceptionalized) [Evolution of Nursing]

Theory Era

• Both research and theory are required to produce nursing science

• Transitioned nursing from a pre-paradigm to a paradigm period (accelerated as early works/curriculum) [Evolution of Nursing]

  
  

Nursing Metaparadigm

1980s [Evolution of Nursing]

Jacqueline Fawcett

Organized framework and global concepts

Person

receipt of care

Theory Utilization Era

21st century [Evolution of Nursing]

Theory Utilization Era

Not practicing the theories conceptionalized in the previous era [Evolution of Nursing]

Theory Utilization Era

What new theories are needed to produce evidence for quality care [Evolution of Nursing]

Theory Utilization Era

• Integrate nursing theories and apply to them to nursing practice

• Moving from learning about theorists to using their theoretical works

• Theories now generate research questions, guide practice, and organize curricula globally(being tested and applied in different researches)

[Evolution of Nursing]

Theory Utilization Era

Development of middle-range theories for evidence based practice [Evolution of Nursing]

Curriculum (1900s-1940s)

standardized curricula [Evolution of Nursing]

Discipline

• academia(domain of knowledge)

• theory

• generate(disciple to practice)

Profession

• practice

• clinical applications

Significance of discipline

• Shift in focus

• Functional focus to a patient focus

Functional focus

relates to what nurses do

Patient focus

utilize what we gained from nursing theories

Analytical paradigm structured on healing

We are there to completely know our patient and knowledge based for the health outcome of our patient

Significance of Profession

• Utilizes specialized, well organized knowledge

• Expands its scientific foundation

• Mandates higher education, Serves human welfare (care for our patients)

• Attain autonomy (distinct body of knowledge not rely on medical knowledge but we recognize medical knowledge)

• Attracts altruistic practitioners (find nursing as a calling)

• Provide professional security

Evidence-Based Practice (EBP)

The direct application of rigorously tested research findings into clinical care to ensure high-quality patient outcomes, rather than relying on personal judgment or emotional bias.

Theory-Guided Research

The process of using theoretical concepts to frame research studies in order to bridge knowledge gaps.

Actionable Clinical Evidence

Verified research findings and insights generated through rigorous testing that can be applied to inform clinical decisions.

Cycle of Knowledge Generation

The continuous, interconnected process wherein theory guides research, research yields clinical evidence, and evidence informs practical patient care.

Empiricists

based conclusion through the five senses

Empiricists

- mechanistic

Empiricists

- quantitative and deductive

Empiricists

- more objective side

Interpretive

- More subjective

Interpretive

holistic, qualitative, and inductive Interpretive

Rationalism

Core approach: relies on prior reasoning and deductive login (moving from general cause to a specific effect)

Rationalism

utilize a theory-then-research strategy

Rationalism

- "If research fails to align the theory must be realigned or discarded”

Rationalism

Ex: nurse assumes that lack of social support can lead to hospital readmissions

Karl Popper

came up with the concept of falsification Falsification

Falsification

- science advances rapidly by attempting to refute theories, not prove them

Falsification

- Ex. Cannot prove every compliant heart failure patient can be readmissioned

Falsification

- Ex. No significant difference between variable x and variable y, true rationalism, you are there to refute that accept or not accept

Empiricism

Core approach: scientific knowledge is derived exclusively from sensory experience and observation

Empiricism

Research then theory strategy believe that we derive from pure knowledge if it comes from the natural world through the 5 senses that we observe

Empiricism

Prior empirical data, prevents premature theory building

Francis Bacon

He pioneered the Empiricism Philosophy

Empiricism

Clinical Example: Formulating a different diagnosis

Disadvantage of Empiricism

may have biases that may impact the results, does not remove the fact that we gather simply facts to conclude to sound conclusion

Rationalism

focuses on theory

Empiricism

focuses research/facts then come up with conclusion

Positivism

logical analysis (deductive), objective, rigorous testing and getting our conclusion from that

Auguste Comte

Introduced positivism

Positivism

emerged as the dominant paradigms of modern science (Ex: scientific method)

Logical empiricism

theoretical propositions must be validated through direct observation

Logical empiricism

Theory must be validated first (exists complete for the theories, object truth that can be discovered)

Logical empiricism

Core belief: empirical facts exist independently of theories, an objective truth wanting to be discovered

Post Positive Shift

Late 20th Century

Foucault, Brown, and Kuhn

challenged strict objectivity

Foucault, Brown, and Kuhn

established that science is a dynamic process, not a static collection of facts

The new epistemology

science is a dynamic process, not a static collection of facts

Post Positive Shift

Pre-existing theories and values heavily influence what a scientist observes

The interactionist approach

observable data and presupposed theories must constantly interact

Myth

science establishes "final, absolute truths" [Science as Consensus & Paradigm Shift] Reality

Reality

- science knowledge is defined by the consensus of scientist based on the best available evidence [Science as Consensus & Paradigm Shift]

Thomas Kuhns

said "Science is always dynamic"

Thomas Kuhns

"Consensus always shift rom time to time"

Thomas Kuhns

"Happens when there is a change"

Normal Science, crisis, Revolution, New Normal Science

Thomas Kuhn's Cycle (1962)

Normal science

widely established as theoretical that is based on established facts Crisis

Crisis

- current theory cannot explain

Revolution

- old theory is already discarded

New Normal Science (paradigm shift)

- New body of knowledge is already added

Interdependence of theory & research

Unified Process: Theory once a concept/research, organizes knowledge

Interdependence of theory & research

Research provide empirical testing, always rely on rigorous testing and scientific consensus

Boundaries, Logic, Correspondence

Scientific consensus criteria