The Discipline of Nursing: Historical Roots, Current Perspectives, Future Directions

The Discipline of Nursing: Historical Roots, Current Perspectives, Future Directions

Maureen C. Shaw, RN, MN
Clinical Nurse Specialist, The Arthritis Society (BC and Yukon Division)
Published in Journal of Advanced Nursing, 1993, 18, 1651-1656
Accepted for publication on 15 February 1993

Introduction

  • Advances in nursing science and research impact nursing education and clinical practice.

  • New perspectives have led to:

    • Re-examination and refinement of traditional concepts: person, environment, health, and nursing.

    • Advancement of nursing knowledge through scientific inquiry.

  • This paper examines nursing as a discipline from three viewpoints:

    1. Historical Past

    2. Current Perspectives

    3. Future Directions

Historical Roots

  • Slow Evolution of Nursing:

    • Originates from:

    • Traditional roles of women.

    • Apprenticeship.

    • Humanitarian aims, religious ideals, intuition, common sense, trial and error.

    • Influences from medicine, technology, politics, war, economics, and feminism (Jacobs & Huether 1978, Keller 1979, others).

  • Florence Nightingale (1969):

    • First nurse-theorist.

    • Viewed nursing as having organized concepts and social relevance distinct from medicine.

  • Virginia Henderson (1965):

    • Defined nursing as a unique, complex service with independent practitioners who were authorities on nursing care.

  • Roger's Holistic View (1970):

    • Advocated for a definition of nursing as an art and a science.

    • Provided a substantive base for theory testing.

  • Donaldson & Crowley (1978):

    • Defined a discipline as a 'unique perspective, a distinct way of viewing all phenomena, which ultimately defines the limits and nature of its inquiry'.

  • Core Themes for Nursing Practice:

    • Laws and principles governing life processes and well-being, influences of the environment on human behavior, processes by which nursing positively affects health, focus on families and communities in nursing practice (Donaldson & Crowley, Fawcett 1984).

  • Hallmark of Success:

    • Consistency over time in identifying nursing's boundaries and domain is a strength and success factor in nursing research and theory development.

Current Perspectives

  • Continuing Contributions:

    • Nurse educators, scholars, clinicians, and researchers work to clarify nursing's role in healthcare and advance knowledge.

    • Transition from haphazard thoughts to systematically organized concepts (Table 1).

  • Ambiguity in Nursing Definition:

    • Despite consensus on a nursing paradigm, the definition remains unclear (Hardy 1978, Jacobs & Huether 1978, others).

  • Hardy's View (1978):

    • Dissent is characteristic of nursing's preparadigmatic stage, where confusion and dispute over theory are normal.

    • Critiqued for measuring nursing against medical science in a negative, linear manner, missing unique contributions of nursing to society.

  • Non-Linear Evolution of Nursing Knowledge:

    • Nursing may not experience periods of normal science (Kuhn 1970) and may evolve indefinitely.

  • Perry's Question (1985):

    • Inquiry about whether nursing discipline has developed sufficiently so nurses can "think nursing".

  • Theoretical Frameworks:

    • Numerous theories and models have been advanced since the 1960s to aid systematic thinking in nursing.

    • Meleis (1987) argued that theory can empower professional autonomy and clinical knowledge.

    • Conceptual development is convoluted, not straightforward.

  • Scholarly Perspectives on Theory:

    • Scholars like Hardy and Northrup advocate for completion of theories and adoption of a specific paradigm, while others like Meleis and Barrett propose a diversity of approaches.

  • Caring as a Central Concept:

    • Watson’s (1988) concept of caring central to nursing models.

    • Leininger (1981) sees caring as unifying in nursing knowledge, while Swanson (1991) sees it as a social process essential but not unique to nursing.

  • Challenges in Caring Integration:

    • Questions remain on how caring integrates with knowing and doing within the nurse-client relationship, highlighting complexity in defining nursing practice.

Theoretical Perspectives

  • Perspective of Nursing Theory Applying to Practice:

    • Engstrom (1984), Bramwell (1985) discuss theory emerging from practice versus pure science (Donaldson & Crowley 1978).

  • Debates on Theory Development:

    • Discussion revolves around whether theory is 'of' nursing or 'for' nursing; a fundamental split in viewing nursing as a basic vs applied science (Barrett 1991).

  • Simultaneity vs Totality Paradigm:

    • Rogers and others advocate 'of' nursing theoretical perspectives, focusing on human beings and environments.

    • The totality paradigm (Roy, Orem) calls for specialty-oriented theories for clinical populations.

  • Practice Discipline Concept:

    • Despite differing paradigms, theoretical perspectives converge in addressing nursing's societal mandate to enhance health and well-being.

    • Integration of theory, research, and practice is essential for nursing’s evolution as a practice discipline.

Future Directions

  • Response to Holistic Health Care:

    • Nursing research is increasingly focused on client and environment understanding (Jennings 1986).

    • The need for methodologies balancing empiricism with humanistic aims in nursing is prominent (Fawcett 1984).

  • Importance of Research Diversity:

    • Inductive and deductive methods valid for nursing knowledge advancement, necessary for addressing clinical concerns.

  • Education and Theory Development:

    • Advancing education in a nursing paradigm rather than medical frameworks is crucial.

    • Further education at various levels (bachelor's, master’s, doctoral) essential for enhancing nursing practice and theory application.

  • Society’s Role:

    • Engaging with consumers to shape nursing research and clinical practices is vital.

  • Nursing's Future Autonomy and Accountability:

    • Balancing self-determination with optimal client outcomes is crucial in fostering theoretical development (Henry et al. 1989, Lutjens 1992).

  • Calls for Integration and Communication:

    • Defining nursing’s identity requires input from practitioners and consumers, advocating for open communication and constructive feedback.

  • Navigating Contemporary Challenges:

    • A proactive approach in theoretical development including bridging research, theory, and practice is essential for nursing’s future.

Conclusion

  • A proactive approach is needed to advance the discipline of nursing.

  • Nursing will evolve to encompass a broader philosophy and knowledge framework beyond present boundaries.

  • As Cicero noted, reason enables problem-solving and coming to conclusions, emphasizing nursing's mission for reasoned inquiry and critical thinking in the discipline’s future development.

Acknowledgements

  • Thanks to Dr. M. Munro RN PhD and Ms. Bey Hills RN MS for their support and feedback on earlier drafts.

References

  • Extensive list of studies, theories, and authors providing foundational concepts in nursing research, theory, and practice.