Nursing Theorists and Their Work 9th Edition PDF

 Philosophy sets forth the meaning of nursing phenomena through analysis, reasoning and logical...

 Philosophy sets forth the meaning of nursing phenomena through analysis, reasoning and logical presentation of concepts and ideas. The Future of Conceptual Models Nursing Theory are sets of concepts Nursing theoretical that address phenomena systems give direction and central to nursing in create understanding propositions that in practice, research, explain the relationship administration, among them. and education. Metaparadigm The broad conceptual boundaries of the discipline of nursing: Human beings, environment, health, Middle-Range Theory and nursing concepts most specific Grand Theory to practice that concepts that derive propose precise testable from a conceptual nursing practice questions and model and propose include details such as patient a testable proposition age group, family situation, Nursing Theory that tests the major health condition, location premise of the model. of the patient, and testable propositions action of the nurse. from philosophies, conceptual models, grand theories, abstract nursing theories, or theories from other disciplines. Theories are less abstract than grand theory and less specific than middle-range theory. Nursing Theorists AND THEIR WORK This page intentionally left blank  Nursing Theorists AND THEIR WORK 9e Martha Raile Alligood, PhD, RN, ANEF Professor Emeritus College of Nursing East Carolina University Greenville, North Carolina 3251 Riverport Lane St. Louis, Missouri 63043 NURSING THEORISTS AND THEIR WORK, NINTH EDITION ISBN: 978-0-323-40224-8 Copyright © 2018 by Elsevier Inc. All Rights Reserved. Previous editions copyrighted © 2014, 2010, 2006, 2002, 1998, 1994, 1989, 1986. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Notices Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary. Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility. With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions. To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for any injury and/or damage to persons or property as a matter of products liability, negli- gence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein. International Standard Book Number: 978-0-323-40224-8 Director, Traditional Education, Nursing Books: Kristin Geen Content Development Manager: Billie Sharp, Lisa Newton Associate Content Development Specialist: Samantha Dalton Publishing Services Manager: Julie Eddy Project Manager: Mike Sheets Design Direction: Brian Salisbury Printed in the United States of America Last digit is the print number: 9 8 7 6 5 4 3 2 1  Dedicated to the memory of my parents: George Fredrick Raile and Winifred Havener Raile, RN They met one snowy night (he was her patient) At Good Samaritan Hospital Zanesville, Ohio CONTRIBUTORS Herdis Alvsvåg, RN, Cand Polit Sandra Schmidt Bunkers, PhD, RN, Robin Harris, PhD, ANP-BC, Professor FAAN ACNS-BC VID Specialized University Adjunct Professor of Nursing Clinical Assistant Professor Oslo, Norway South Dakota State University College of Nursing Brookings, South Dakota University of Tennessee Mary T. Antonelli, PhD(c), RN Knoxville, Tennessee PhD Candidate Sherrilyn Coffman, PhD, RN, COI Boston College Professor Bonnie Holaday, PhD, RN, FAAN Chestnut Hill, Massachusetts School of Nursing Professor Emerita Nevada State College School of Nursing Donald E. Bailey, Jr., PhD, RN, FAAN Henderson, Nevada Clemson University Associate Professor Clemson, South Carolina School of Nursing Thérèse Dowd, PhD, RN Duke University Associate Professor Emeritus Eun-Ok Im, PhD, MPH, RN, CNS, Durham, North Carolina College of Nursing FAAN University of Akron Professor & Mary T. Champagne Barbara E. Banfield, PhD, RN Akron, Ohio Professor Associate Professor School of Nursing Madonna University Margaret E. Erickson, PhD, RN, Duke University Livonia, Michigan CNS, APHN-BC Durham, North Carolina CEO Violeta A. Berbiglia, EdD, MSN American Holistic Nurses Credentialing Dorothy Jones, EdD, MSN, BSN Associate Professor, Retired Corporation Senior Nurse Scientist School of Nursing Cedar Park, Texas Massachusetts General Hospital The University of Texas Health Science Boston, Massachusetts Center at San Antonio Mary Gunther, PhD, RN Professor San Antonio, Texas Associate Dean Boston College Academic Affairs Chestnut Hill, Massachusetts Debra A. Bournes, RN, PhD University of Tennessee Chief Nursing Executive and Vice Knoxville, Tennessee Lisa Kitko, PhD, RN, FAHA President Clinical Programs Assistant Professor The Ottawa Hospital Dana M. Hansen, PhD, APRN, College of Nursing Ottawa, Canada ACHPN The Pennsylvania State University Assistant Professor University Park, Pennsylvania Nancy Brookes, PhD, RN, MSc(A) College of Nursing Nurse Scholar Kent State University Theresa Gunter Lawson, PhD, Adjunct Professor Kent, Ohio APRN, FNP-BC, CNE University of Ottawa Faculty of Health Visiting Professor Sciences—Nursing Sonya R. Hardin, PhD, RN, CCRN, Chamberlain College of Nursing Ottawa, Canada NP-C Family Nurse Practitioner Professor Neuman Systems Model Trustees Group Karen A. Brykczynski, PhD, RN, College of Nursing Anderson Free Clinic FNP, FAAN East Carolina University Anderson, South Carolina Professor, Retired Greenville, North Carolina School of Nursing at Galveston The University of Texas Medical Branch Galveston, Texas vi  CONTRIBUTORS vii Danielle Leone-Sheehan, Patricia R. Messmer, PhD, MA, Marguerite J. Purnell, PhD, RN, MSN, RN MSN, FAAN AHN-BC PhD Candidate Consultant for Nursing Research & Professor Emeritus Connell School of Nursing Education Christine E. Lynn College of Nursing Boston College Benjamín León School of Nursing Florida Atlantic University Chestnut Hill, Massachusetts Miami Dade College Boca Raton, Florida Miami, Florida Unni Å. Lindström, PhD, RN Pamela G. Reed, PhD, MSN, MA, Professor Emerita Gail J. Mitchell, RN, PhD FAAN Department of Caring Science Professor Professor Åbo Academy University School of Nursing College of Nursing Vasa, Finland York University The University of Arizona Toronto, Canada Tucson, Arizona M. Katherine Maeve, PhD, RN Adjunct Faculty Julie L. Murphy, MSN, RN Teresa J. Sakraida, PhD, RN Augusta University Doctoral Candidate Associate Professor Augusta, Georgia College of Nursing Christine E. Lynn College of Nursing Mental Health Outpatient Case The Pennsylvania State University Florida Atlantic University Manager University Park, Pennsylvania Boca Raton, Florida Charlie Norwood Veterans Medical Center Lisbet Lindholm Nyström, PhD, RN Ann M. Schreier, PhD, RN Augusta, Georgia Associate Professor, Retired Associate Professor Department of Caring Science College of Nursing Marilyn R. McFarland, PhD, RN, Åbo Academy University East Carolina University FNP-BC, CTN-A Vasa, Finland Greenville, North Carolina Professor of Nursing and Family Nurse Practitioner, Advanced Certified Janice Penrod, PhD, RN, FGSA, FAAN Carrie Scotto, PhD, RN Transcultural Nurse, Author Professor Associate Professor Department of Nursing College of Nursing College of Nursing University of Michigan—Flint The Pennsylvania State University University of Akron Flint, Michigan University Park, Pennsylvania Akron, Ohio Gwen McGhan, PhD, RN Susan A. Pfettscher, PhD, RN Christina Leibold Sieloff, PhD, RN Assistant Professor Clinical Nurse Associate Professor School of Nursing PD Program College of Nursing University of Alabama at Birmingham DaVita Montana State University Birmingham, Alabama Templeton, California Bozeman, Montana Linda C. Mefford, PhD, APRN, Kenneth D. Phillips, PhD, RN Cynthia K. Snyder, MSN, RN NNP-BC, RNC-NIC Professor and Associate Dean for Doctoral Student Associate Professor Research The Pennsylvania State University Bellarmine University College of Nursing University Park, Pennsylvania Louisville, Kentucky East Tennessee State University Johnson City, Tennessee Janet L. Stewart, PhD, RN Molly Meighan, PhD, RNC-e Dean Professor Emerita Marie E. Pokorny, PhD, RN Faculty of the Health Sciences Division of Nursing Professor Emerita of Nursing Kibogora Polytechnic Institute Carson-Newman University College of Nursing Kirambo, Rwanda, Africa Jefferson City, Tennessee East Carolina University Greenville, North Carolina viii CONTRIBUTORS Danny G. Willis, DNS, RN, Danuta M. Wojnar, PhD, RN, FAAN Joan E. Zetterlund, PhD, RN PMHCNS-BC Professor & Associate Dean Professor Emerita Associate Professor & Department Chair Undergraduate Education School of Nursing Connell School of Nursing College of Nursing North Park University Boston College Seattle University Chicago, Illinois Chestnut Hill, Massachusetts Seattle, Washington Jane C. Wilson, MSN, RN Assistant Professor of Nursing Palm Beach Atlantic University West Palm Beach, Florida  REVIEWERS Karen E. Alexander, PhD, RN, Karen Pennington, PhD, RN Wendy Wheeler, RN, BScN, MN CNOR Director RN-BSN and MS Leadership Instructor Program Director and Assistant Programs Red Deer College Professor RN-BSN Loretto Heights School of Nursing Alberta, Canada University of Houston - Clear Lake Regis University Houston, Texas Denver, Colorado Sarah J. Williams, BSN, MA, MSN, PhD ChengChing Hiya Liu, RN, PhD, Lynda F. Turner, EdD, MSN, RN, Professor and Director RN-BSN-MSN MBA ACNS-BC, CNE Nursing Program Assistant Professor Associate Professor and Director Ila Faye Miller School of Nursing College of Nursing of BSN Program and Health Professions Michigan State University Marshall University University of the Incarnate Word East Lansing, Michigan Huntington, West Virginia San Antonio, Texas Ronda Mintz-Binder, DNP, RN, CNE Clinical Associate Professor College of Nursing Health Innovation University of Texas at Arlington Arlington, Texas ix AB OUT THE EDITOR Martha Raile Alligood is South Carolina, University of Tennessee and East Carolina professor emeritus at East University. Among professional memberships are Epsilon Carolina University College and Beta Nu Chapters of Sigma Theta Tau International of Nursing in Greenville, (STTI) and Society of Rogerian Scholars (SRS). North Carolina, where she A recipient of numerous awards and honors, she is a was Director of the Nursing National League for Nursing (NLN) Academy of Nursing PhD program. A graduate Education Fellow (ANEF). She received the SNRS Leader- of Good Samaritan School ship in Research Award, and the East Carolina University of Nursing, she also holds Chancellors’s Women of Distinction Award. As a member a bachelor of sacred litera- of the Board of Trustees at Johnson University, Dr. Alligood ture (BSL) from Johnson chairs the Academic Affairs Committee. University, a bachelor of She is known nationally and internationally for expertise science in nursing (BSN) from University of Virginia, a in nursing theory, was contributing editor for the Theoretical master of science (MS) with a major in nursing from The Concerns column, Nursing Science Quarterly, vol. 24, 2011, Ohio State University, and a doctorate of philosophy (PhD) and Consultant and Interviewer for The Nurse Theorists: in nursing science from New York University. Portraits of Excellence, vol. II, 2008 and vol. III, 2016, video Her career in nursing education began in Rhodesia, series for Fitne, Inc. Athens, OH. She is author and editor of (now Zimbabwe) Africa and has included graduate faculty Nursing Theory: Utilization & Application, fifth edition, as appointments at the University of Florida, University of well as this ninth edition of Nursing Theorists and Their Work. Photo credit: Center for Health Sciences Communication, Brody School of Medicine, East Carolina University, Greenville, NC x  P R E FA C E This book is a tribute to nursing theorists and a classic in The works of nurse theorists from around the world theoretical nursing literature. It presents many major think- are featured in this text, including works by interna- ers in nursing, reviews their important knowledge-building tional theorists that have been translated into English. ideas, lists their publications, and points the reader to those Nursing Theorists and Their Work has also been trans- using the works and writing about them in their own theo- lated into numerous languages for nursing faculty and retical publications. students in other parts of the world as well as nurses in The Unit I opener introduces the reader to a graphic practice. that is a new feature in this ninth edition. This graphic Nurses and students at all stages of their education and illustrates the type of theoretical work presented in that nursing career are interested in learning about nursing Unit in relation to the types of works in the other Units. theory and the use of theoretical works from around the Unit I highlights the core: person, environment, health & world. Those just beginning their nursing education, such nursing, the metaparadigm concepts forming nursing’s as associate degree and baccalaureate students, will find the disciplinary boundaries. life of the theorists, their conceptual focus, definitions, Unit I has been reorganized to better introduce the and theoretical assertions interesting. Graduate students, at reader to the organization of the text. A brief history of the master and doctoral levels, will be more attracted to the nursing knowledge development and its significance to the logical form, acceptance by the nursing community, the discipline and practice of the profession is presented in theoretical sources for theory development, the use of Chapter 1. Chapter 2 continues the historical introduction empirical data, and the analyses of each work. The refer- with 10 works from earlier editions of Nursing Theorists and ences and bibliographies are particularly useful to graduate Their Work presented briefly as nursing theorists of histori- students for locating primary and secondary sources that cal significance. They are Peplau; Henderson; Abdellah; augment the websites specific to the theorist. The following Wiedenbach; Hall; Travelbee; Barnard; Adam; Orlando; comprehensive websites are excellent resources for infor- and the work of Roper, Logan, Tierney. An introduction to mation about theory research and links to the individual the history and philosophy of science, logical reasoning, and theorists featured in this book: theory development processes are presented in Chapters 3 Nursing Theory Link Page, Clayton College and State and 4. Finally Chapter 5 presents an introduction to nurs- University, Department of Nursing: http://www.clayton ing knowledge, types of knowledge, the framework used.edu/nursing/Nursing-Theory for analysis of each theoretical work, and the content out- Nursing Theory and Research page, Hahn School of line for Chapters 6–36. Nursing and Health Science, University of San Diego: In Unit II, the philosophies of Nightingale, Watson, Ray, https://www.sandiego.edu/nursing/research/nursing- Benner, Martinsen, and Eriksson are presented. Unit III theory-research.php includes nursing models by Levine, Rogers, Orem, King, A comprehensive collection of nursing theory media, Neuman, Roy, and Johnson. The work of Boykin and The Nurse Theorists: Portraits of Excellence, Vol. I, Vol. II, Schoenhofer begins Unit IV on nursing theory, followed by Vol. III and Nurse Theorists: Excellence in Action: https:// the works of Meleis; Pender; Leininger; Newman; Parse; www.fitne.net/nurse_theorists.jsp Erickson, Tomlin, and Swain; and the Husteds. Unit V The works of the theorists presented in this text have presents middle-range theoretical works of Mercer; Mishel; stimulated phenomenal growth in nursing literature and Reed; Wiener and Dodd; Eakes, Burke, and Hainsworth; enriched the professional lives of nurses around the world Barker; Kolcaba; Beck; Swanson; Ruland; and Moore. by guiding nursing research, education, administration, Unit VI offers three perspectives on the status of the art and practice. The professional growth continues to in- and science of nursing theory: expansion of the philosophy crease as we analyze and synthesize these works, generate of nursing science, the advance of theory development in new ideas, and develop new theory and applications for this theory utilization era, and the global evidence of nurs- education in the discipline and high quality care in practice ing theoretical works in the nursing literature worldwide. by nurses. xi AC K N OW L E D G M E N T S I am thankful to the theorists who critiqued the original I want to thank Dr. Marie E. Pokorny, whom I consulted and subsequent chapters about themselves to keep the on the reorganization of Unit I. She provided support and content current and accurate. The work of Paterson and wise counsel to better reflect the flow of history for the Zderad was omitted at their request. beginning student in Unit I of this ninth edition. I am very grateful to those who have contributed or As in most new editions, I welcome new chapter authors worked behind the scenes with previous editions to de- and doctoral student contributors to this ninth edition: velop this text over the years. In the third edition, I joined Dr. Danny Willis and Danielle M. Leone-Sheehan to Ann Marriner Tomey, serving as a contributing author, to Chapter 7 on Jean Watson, Dr. Linda Mefford to Chapter 12 reorder the chapters and edit for consistency with the new on Myra Estrin Levine, Jane Wilson to Chapter 21 on organization of the text. Subsequently I was invited by Nola J. Pender, Dr. Dorothy Jones and Mary Antonelli to Mosby personnel to design and coedit a practice-focused Chapter 23 on Margaret Newman, Dr. Sandra Bunkers to nursing theory text, Nursing Theory: Utilization and Appli- Chapter 24 on Rosemary Parse, Dr. Pam Reed to Chapter 29 cation. Beginning with the fifth edition of this text, Ann on Pam Reed, and Julie L. Murphy and Cynthia K. Snyder Marriner Tomey invited me to coedit and contribute to to Chapter 30 on Carolyn L. Wiener and Marilyn J. Dodd. two more editions (fifth and sixth) of Nursing Theorists Finally, I would like to thank the publishers at Elsevier and Their Work. After Ann retired, I completed the seventh, for their guidance and assistance through the years to eighth, and ninth editions. I recognize Ann Marriner bring this text to this ninth edition. The external reviews Tomey for her vision to develop this book. Her mentor- requested by Elsevier editors have contributed to the suc- ship, wisdom, and collegial friendship contributed to cessful development of each new edition. The chapter au- the development of my professional career. She is to be thors, who over the years have contributed their expert commended for initiating this text that continues to make knowledge of the theorists and their work, continue to valuable global contributions to the discipline and the make a most valuable contribution. profession of nursing. Martha Raile Alligood xii  CONTENTS UNIT I Evolution of Nursing Theories 11 Katie Eriksson: Theory of Caritative Caring, 140 Unni Å. Lindström, Lisbet Lindholm Nyström, 1 Introduction to Nursing Theory: Its History and Joan E. Zetterlund and Significance, 2 Martha Raile Alligood 2 Nursing Theorists of Historical Significance, 11 UNIT III Nursing Conceptual Models Marie E. Pokorny Hildegard E. Peplau 12 Myra Estrin Levine: The Conservation Model, 165 Virginia Henderson Linda C. Mefford Faye Glenn Abdellah 13 Martha E. Rogers: Unitary Human Beings, 180 Ernestine Wiedenbach Mary E. Gunther Lydia Hall 14 Dorthea E. Orem: Self-Care Deficit Theory of Joyce Travelbee Nursing, 198 Kathryn E. Barnard Violeta A. Berbiglia and Barbara Banfield Evelyn Adam 15 Imogene M. King: Conceptual System and Nancy Roper Middle-Range Theory of Goal Attainment, 213 Winifred W. Logan Christina L. Sieloff and Patricia R. Messmer Alison J. Tierney 16 Betty Neuman: Systems Model, 231 Ida Jean (Orlando) Pelletier Theresa Gunter Lawson 3 History of Nursing Science, 28 17 Sister Callista Roy: Adaptation Model, 249 Sonya R. Hardin Kenneth D. Phillips and Robin Harris 4 Theory Development Process, 35 18 Dorothy E. Johnson: Behavioral System Sonya R. Hardin Model, 273 5 The Structure and Analysis of Specialized Nursing Bonnie Holaday Knowledge, 44 Martha Raile Alligood UNIT IV Theories and Grand Theories UNIT II Nursing Philosophies 19 Anne Boykin and Savina O. Schoenhofer: The Theory of Nursing as Caring: A Model 6 Florence Nightingale: Modern Nursing, 50 for Transforming Practice, 293 Susan A. Pfettscher Marguerite J. Purnell 7 Jean Watson: Watson’s Philosophy and Theory 20 Afaf Ibrahim Meleis: Transitions Theory, 309 of Transpersonal Caring, 66 Eun-Ok Im Danny G. Willis and Danielle M. Leone-Sheehan 21 Nola J. Pender: Health Promotion Model, 323 8 Marilyn Anne Ray: Theory of Bureaucratic Teresa J. Sakraida and Jane Wilson Caring, 80 22 Madeleine M. Leininger: Theory of Culture Care Sherrilyn Coffman Diversity and Universality, 339 9 Patricia Benner: Caring, Clinical Wisdom, Marilyn R. McFarland and Ethics in Nursing Practice, 98 23 Margaret A. Newman: Health as Expanding Karen A. Brykczynski Consciousness, 359 10 Kari Martinsen: Philosophy of Caring, 120 Dorothy Jones and Mary Antonelli Herdis Alvsvåg xiii xiv CONTENTS 24 Rosemarie Rizzo Parse: Humanbecoming, 375 32 Phil Barker: The Tidal Model of Mental Health Debra A. Bournes, Sandra Schmidt Bunkers, Recovery, 504 and Gail J. Mitchell Nancy Brookes 25 Helen C. Erickson, Evelyn M. Tomlin, Mary Ann P. 33 Katharine Kolcaba: Theory of Comfort, 527 Swain: Modeling and Role-Modeling, 398 Thérèse Dowd Margaret E. Erickson 34 Cheryl Tatano Beck: Postpartum Depression 26 Gladys L. Husted and James H. Husted: Theory, 540 Symphonological Bioethical Theory, 417 M. Katherine Maeve Carrie Scotto 35 Kristen M. Swanson: Theory of Caring, 553 Danuta M. Wojnar 36 Cornelia M. Ruland and Shirley M. Moore: UNIT V Middle-Range Theories Peaceful End-of-Life Theory, 564 Dana M. Hansen 27 Ramona T. Mercer: Maternal Role Attainment— Becoming a Mother, 432 Molly Meighan UNIT VI The Future of Nursing Theory 28 Merle H. Mishel: Uncertainty in Illness Theory, 447 Donald E. Bailey, Jr., and Janet L. Stewart 37 State of the Art and Science of Nursing 29 Pamela G. Reed: Self-Transcendence Theory, 463 Theory, 573 Pamela G. Reed Martha Raile Alligood 30 Carolyn L. Weiner and Marilyn J. Dodd: Theory of Illness Trajectory, 477 Index, 579 Lisa Kitko, Gwen McGhan, Julie L. Murphy, Cynthia K. Snyder, and Janice Penrod 31 Georgene Gaskill Eakes, Mary Lermann Burke, Margaret A. Hainsworth: Theory of Chronic Sorrow, 490 Ann M. Schreier  UNIT I Evolution of Nursing Theories Nurse scholars led the search for specialized theoretical nursing knowledge to guide education, professional practice, research, and administration. Nursing history and significant developments demonstrate the incredible influence theory has had on nursing as a specialized field of practice (the profession) and a division of education (the discipline). Nursing followed a developmental path from concepts to conceptual frameworks to models to theories to practice-level middle-range theories in the theory utilization era. Knowledge of the role of concepts in the theory development process contributes to an understanding of the theoretical works of the discipline of nursing. Theory plays a major role in knowledge development by specifying the question and the approach and guiding the research process. Analysis facilitates learning through systematic review and critical reflection of the theoretical works of the discipline. Theory analysis begins the process of identifying a decision-making framework for nursing practice or research. Philosophy sets forth the meaning of nursing phenomena through analysis, reasoning and logical presentation of concepts and ideas. The Future of Conceptual Models Nursing Theory are sets of concepts Nursing theoretical that address phenomena systems give direction and central to nursing in create understanding propositions that in practice, research, explain the relationship administration, among them. and education. Metaparadigm The broad conceptual boundaries of the discipline of nursing: Human beings, environment, health, Middle-Range Theory and nursing concepts most specific Grand Theory to practice that concepts that derive propose precise testable from a conceptual nursing practice questions and model and propose include details such as patient a testable proposition age group, family situation, Nursing Theory that tests the major health condition, location premise of the model. of the patient, and testable propositions action of the nurse. from philosophies, conceptual models, grand theories, abstract nursing theories, or theories from other disciplines. Theories are less abstract than grand theory and less specific than middle-range theory. 1  1 Introduction to Nursing Theory: Its History and Significance Martha Raile Alligood* “The systematic accumulation of knowledge is essential to progress in any profession... however theory and practice must be constantly interactive. Theory without practice is empty and practice without theory is blind.” (Cross, 1981, p. 110) This text is designed to introduce nursing theorists and contributes meaning to an understanding of the contri- their work. Nursing theory became a major theme in the butions of the nurse theorists and their work. A brief last half of the 20th century, and it continues to stimulate history of nursing development from vocational to phenomenal professional growth globally and expansion professional presents a description of the search for sub- of nursing literature and education around the world. stantive nursing knowledge on which to base nursing The nursing theorists presented in this text are selected practice. The progressive search ultimately led to this to introduce students at all levels of nursing to a broad exciting time of theory utilization in nursing history. The range of nurse theorists and various theoretical works. history of this development provides context and per- Although nurses of early eras often delivered excellent spective to understand the continuing significance of care to patients, much of what was known about nursing nursing theory. As nursing advanced, the significance was not tested or used uniformly in practice or educa- of nursing theory became more clear for both the disci- tion. Rather ideas that were passed on through education pline and profession of nursing. focused on skills and functional tasks about nursing practices that seemed effective. Therefore a major goal was put forth by nursing leaders in the 20th century HISTORY OF NURSING THEORY for the development of nursing knowledge on which The history of professional nursing began with Florence to base nursing practice, improve quality of care, and Nightingale. Nightingale envisioned nurses as a body of gain recognition of nursing as a profession. The history educated women at a time when women were neither of nursing clearly documents sustained efforts toward educated nor employed in public service. After her war- that goal of developing a specialized body of nursing time service of organizing and caring for the wounded in knowledge to guide nursing practice (Alligood, 2014; Scutari during the Crimean War, Nightingale’s vision Alligood & Tomey, 1997; Bixler & Bixler, 1959; Chinn and establishment of a School of Nursing at St. Thomas’ & Kramer, 2015; George, 2011; Im & Chang, 2012; Hospital in London marked the birth of modern nursing. Judd & Sitzman, 2013; McCrae, 2012; Meleis, 2012; Nightingale’s pioneering activities in nursing practice and Shaw, 1993). education and her subsequent writings became a guide for This chapter introduces nursing theory from two establishing nursing schools and hospitals in the United important perspectives: history and significance. Each States at the beginning of the 20th century (Judd & Sitzman, 2013; Kalisch & Kalisch, 2003; Nightingale, 1859/1969). Nightingale’s (1859/1969) vision of nursing has been *Previous authors: Martha Raile Alligood, Elizabeth Chong Choi, practiced for more than a century, and theory development Juanita Fogel Keck, and Ann Marriner Tomey. in nursing has evolved rapidly over the past 6 decades, 2  CHAPTER 1 Introduction to Nursing Theory: Its History and Significance 3 leading to the recognition of nursing as an academic of the 20th-century diploma programs began closing discipline with a specialized body of knowledge (Alligood, and significant numbers of nursing education programs 2014; Bixler & Bixler, 1959; Chinn & Kramer, 2015; opened in colleges and universities (Ervin, 2015; Judd & Fawcett & DeSanto-Medeya, 2013; Im & Chang, 2012; Sitzman, 2013; Kalisch & Kalisch, 2003). The curriculum Walker & Avant, 2011). It was during the mid-1800s that era emphasized course selection and content for nursing Nightingale recognized the unique focus of nursing and programs and gave way to the research era, which focused declared nursing knowledge as distinct from medical on the research process and the long-range goal of acquir- knowledge. She described a nurse’s proper function as ing substantive knowledge to guide nursing practice. putting the patient in the best condition for nature As nurses increasingly sought degrees in higher educa- (God) to act upon him or her. She set forth the following: tion, the research emphasis era began to emerge. During that care of the sick is based on knowledge of persons the midcentury more nurse leaders embraced higher edu- and their surroundings—a different knowledge base than cation and arrived at an understanding of the scientific age that used by physicians in their practice (Nightingale, and that research was the path to new nursing knowledge. 1859/1969). Despite this early edict from Nightingale in Nurses began to participate in research, and research the 1850s, it was 100 years later, during the 1950s, when courses were included in nursing curricula in early gradu- nursing profession leaders began serious discussion of ate nursing programs (Alligood, 2014). In the mid-1970s, the need to develop nursing knowledge apart from med- an evaluation of the first 25 years of the journal Nursing ical knowledge to guide nursing practice. This awareness Research revealed that nursing studies lacked conceptual of the need to develop nursing knowledge continued to connections and theoretical frameworks, accentuating grow (Alligood, 2014; Chinn & Kramer, 2015; Meleis, their necessity for the development of specialized nursing 2012; Walker & Avant, 2011). Until the proposal of nurs- knowledge (Batey, 1977). Awareness of the need for con- ing as a science in the 1950s, nursing practice was based cept and theory development coincided with two other on principles and traditions that were handed down milestones in the evolution of nursing theory: the stan- through an apprenticeship model of education and in- dardization of curricula for a nursing master’s education dividual hospital procedure manuals (Alligood, 2014; by the National League for Nursing accreditation criteria Kalisch & Kalisch, 2003). Although some nursing lead- for baccalaureate and higher-degree programs, and the ers aspired for nursing to be recognized as a profession decision that doctoral education for nurses should be in and become an academic discipline, nursing practice re- nursing (Alligood, 2014). flected its vocational heritage more than its professional The research era and the graduate education era devel- vision. The transition from vocation to profession is de- oped in tandem. Master’s degree programs in nursing scribed here in successive eras of history as nurses began emerged across the country to meet the public need for developing a body of specialized knowledge on which to nurses for specialized clinical nursing practice. Many of base nursing practice. Nurses began with a strong em- these graduate programs included a course that introduced phasis on practice, and worked throughout the century the student to the research process. Also during this era, toward the development of nursing as a profession. nursing master’s programs began to include courses in Progress in each of these eras toward the goal of a spe- concept development and nursing models, introducing cialized basis for nursing practice demonstrates the seri- students to early nursing theorists and knowledge develop- ousness of this drive toward professional development ment processes (Alligood, 2014). The development of (Alligood, 2014). nursing knowledge was a major force at this time. The The curriculum era addressed the question of what baccalaureate degree began to gain wider acceptance as the content nurses should study to learn how to be a nurse. educational level for professional nursing, and nursing During this era, the emphasis was on what courses nursing attained nationwide recognition and acceptance as an aca- students should take, with the goal of arriving at a stan- demic discipline in higher education. Nurse researchers dardized curriculum (Alligood, 2014). By the mid-1930s, a worked to develop and clarify a specialized body of nursing standardized curriculum had been published and adopted knowledge, with the goals of improving the quality of by many diploma nursing programs, where nursing was patient care, providing a professional style of practice, and taught at the time. The idea of moving nursing education achieving recognition as a profession. There were debates from hospital-based diploma programs into colleges and and discussions in the 1960s regarding the proper direction universities began to emerge during this era (Ervin, 2015; and appropriate discipline for nursing knowledge develop- Judd & Sitzman, 2013). However, despite this early concept ment. In the 1970s, nursing continued to make the transi- of nursing education, it was the middle of the century be- tion from vocation to profession as nurse leaders debated fore most states acted upon this goal, and the second half whether nursing should be other-discipline based or nursing 4 UNIT I Evolution of Nursing Theories based. History records the outcome: that nursing practice about the theorists to use of the theoretical works to gen- is to be based on nursing science (Alligood, 2014; Fawcett, erate research questions, guide practice, and organize 1978; Nicoll, 1986). It is as Meleis (2007) noted, “theory is curricula. Evidence of this growth of theoretical works not a luxury in the discipline of nursing... but an integral has proliferated in podium presentations at national and part of the nursing lexicon in education, administration, international conferences, and in newsletters, journals, and practice” (p. 4). An important precursor to the theory and books written by nurse scientists who are members of era was the general acceptance of nursing as a profession societies or communities of scholars for nursing models and an academic discipline in its own right. and theories. Members contribute to the general nursing The theory era was a natural outgrowth of the research literature and communicate their research and practice and graduate education eras (Alligood, 2014; Im & Chang, with a certain paradigm model or framework at confer- 2012). The explosive proliferation of nursing doctoral ences of the societies where they present their scholarship programs from the 1970s and nursing theory literature and move the science of the selected paradigm forward substantiated that nursing doctorates should be in nursing (Alligood, 2014; Fawcett & Garity, 2009; Im & Chang, rather than in other disciplines (Nicoll, 1986, 1992, 1997; 2012; Smith & Parker, 2014). Reed & Shearer, 2009, 2012; Reed, Shearer, & Nicoll, 2003). These observations of nursing theory development As understanding of research and knowledge development progress bring Kuhn’s (1970) description of normal sci- increased, it became obvious that research without concep- ence to life. His philosophy of science clarifies an under- tual and theoretical frameworks produced isolated infor- standing of the evolution of nursing theory through para- mation rather than a body of nursing knowledge. Under- digm science. It is important historically to understand standing that both research and theory were required to that what we view collectively today as nursing models produce nursing science moved nurses forward toward and theories is the work of individuals who originally their goal (Batey, 1977; Fawcett, 1978; Hardy, 1978). Doc- published their ideas and conceptualizations of nursing in toral education in nursing began to develop with a strong various areas of the country and around the world. These emphasis on theory development and testing. The theory works later were viewed collectively within a systematic era accelerated as early works developed as frameworks for structure of knowledge according to analysis and evalua- curricula and advanced practice guides began to be recog- tion (Fawcett, 1984, 1993, 2005). Theory development nized as theory. In fact, the Nurse Educator Nursing The- emerged as a process and product of professional scholar- ory Conference in New York City in 1978 presented a ship and growth among nurse leaders, administrators, group of nursing theorists in a program together for the educators, and practitioners who sought higher educa- first time (Alligood, 2014; Fawcett, 1984). tion. These leaders recognized limitations of theory from The 1980s was a period of major developments in other disciplines to describe, explain, or predict nursing nursing theory that has been characterized as a transition outcomes, and they labored to establish a scientific basis from the preparadigm to the paradigm period in nursing for nursing curricula, practice, research, and management. (Fawcett, 1984; Hardy, 1978; Kuhn, 1970). The prevailing The development and use of theory led to what is recog- nursing paradigms (models) provided perspectives for nized today as the nursing theory era (Alligood, 2014; education, nursing practice, research, administration, and Nicoll, 1986, 1992, 1997; Reed & Shearer, 2012; Reed, further theory development. In the 1980s, Fawcett’s semi- Shearer, & Nicoll, 2003; Wood, 2014). It was as Fitzpatrick nal proposal of four global nursing concepts as a nursing and Whall (1983) had said, “nursing is on the brink of an metaparadigm served as an organizing structure for exist- exciting new era” (p. 2). This awareness ushered in the ing nursing frameworks and introduced a way of organiz- theory utilization era. ing individual theoretical works in a meaningful structure The accomplishments of normal science accompanied (Fawcett, 1978, 1984, 1993). Classifying the nursing mod- the theory utilization era as emphasis shifted to theory els as paradigms within metaparadigm concepts of per- application in nursing practice, education, research, and son, environment, health, and nursing systematically administration (Alligood, 2014; Wood, 2014). In this era, united nursing theoretical works for the discipline. This middle-range theory and the value of a nursing framework system clarified and improved comprehension of knowl- for thought and action in nursing practice was realized. edge development by positioning the theorists’ works in a The shift in emphasis to the application of nursing theory larger context, thus greatly facilitating the growth of nurs- was extremely important for theory-based nursing, ing science (Fawcett, 2005). The body of nursing science in evidence-based practice, and future theory development research, education, administration, and practice contin- (Alligood, 2010, 2014; Alligood & Tomey, 1997, 2002, ues to expand through nursing scholarship. In the last de- 2006; Chinn & Kramer, 2015; Fawcett, 2005; Fawcett & cades of the 20th century, emphasis shifted from learning Garity, 2009). The fifth edition of Nursing Theory: Utilization  CHAPTER 1 Introduction to Nursing Theory: Its History and Significance 5 TABLE 1.1 Historical Eras of Nursing’s Search for Specialized Knowledge Historical Era Major Question Emphasis Outcomes Emerging Goal Curriculum era: What curriculum con- Courses included in Standardized curri- Develop specialized 1900–1940s tent should student nursing programs. cula for diploma knowledge and nurses study to be programs. higher education. nurses? Research era: What is the focus for Role of nurses and Problem studies and Isolated studies do 1950–1970s nursing research? what to research. studies of nurses. not yield unified knowledge. Graduate education What knowledge is Carving out an ad- Nurses have an Focus graduate era: 1950–1970s needed for the vanced role and important role in education on practice of nursing? basis for nursing health care. knowledge practice. development. Theory era: How do these frame- There are many Nursing theoretical Theories guide 1980–1990s works guide research ways to think works shift the fo- nursing research and practice? about nursing. cus to the patient. and practice. Theory utilization What new theories Nursing theory Middle-range theory Nursing frameworks era: 21st century are needed to guides research, may be from quan- produce knowledge produce evidence practice, education, titative or qualitative (evidence) for for quality care? and administration. approaches. quality care. Alligood, M. R. (2014). Nursing theory: Utilization & application. St Louis: Mosby-Elsevier. & Application (Alligood, 2014) offers numerous case also contributed to recognition of nursing as a profes- applications of nursing theoretical works in practice. sion and a discipline. Table 1.1 presents a summary of the eras of nursing’s The achievements of the profession over the past cen- search for specialized nursing knowledge. Within each era, tury were highly relevant to nursing science development, the pervading question “What is the nature of the knowl- but they did not come easily. History shows that many edge that is needed for the practice of nursing?” was nurses pioneered the cause of human health and chal- addressed at the prevailing level of understanding at the lenged the status quo with creative ideas for both the time (Alligood, 2014). health of people and the development of nursing. Their This brief history provides some background and achievements ushered in this exciting time (Kalisch & context for the study of nursing theorists and their work. Kalisch, 2003; Meleis, 2012; Shaw, 1993). Since the publi- The theory utilization era continues to emphasize the cation of the first edition of Nursing Theorists and Their development and use of nursing theory and to produce Work (1986), the volume of theoretical works has ex- evidence for quality professional practice. New theory panded considerably. There are nurses who made signifi- and new methodologies from qualitative research ap- cant contributions during the preparadigm period of proaches continue to expand Carper’s (1978) ways of nursing knowledge development (Hardy, 1973, 1978). knowing among nurse scientists. The use of nursing phi- However, references to those early works in the literature losophies, models, theories, and middle-range theories became increasingly limited despite their important con- for the thought and action of nursing practice contrib- tributions. Therefore in the sixth edition of this text utes important evidence for quality care in all areas (2006), a chapter of ten selected exemplars from that early of current practice (Alligood, 2014; Fawcett, 2005; development were recognized for their significant nursing Fawcett & Garity, 2009; Peterson & Bredow, 2014; Smith knowledge contributions. Chapter 2 of this text presents & Leihr, 2013; Wood, 2014). Practice in nursing today those selected exemplars (Box 1.1) of early works and requires knowledge of and use of the theoretical works their updates to further explore the history and signifi- of the discipline (Alligood, 2014). Not only is theory cance of nursing theory in the discipline of nursing. Those relevant in the history of nursing’s progress toward interested in learning more about these early nursing specialized nursing knowledge, but that knowledge pioneers or any theorist whose work is included in this 6 UNIT I Evolution of Nursing Theories Significance for the Discipline BOX 1.1 Early Theorists of Historical When nurses entered baccalaureate and higher-degree pro- Significance grams in universities during the last half of the 20th cen- Hildegard E. Peplau 1909–1999 tury, the goal of developing knowledge as a basis for nurs- Virginia Henderson 1897–1996 ing practice began to be realized. University baccalaureate Faye Glenn Abdellah 1919 to present programs proliferated, master’s programs in nursing were Earnestine Wiedenbach 1900–1996 developed, and a standardized curriculum was realized Lydia Hall 1906–1969 through accreditation. Nursing had passed through eras of Joyce Travelbee 1926–1973 gradual development, and nursing leaders offered their Kathryn E. Barnard 1938 to present perspectives on the development of nursing science. They Evelyn Adam 1929 to present addressed significant disciplinary questions about whether Nancy Roper* 1918–2004 nursing was an applied science or a basic science (Donaldson Winifred Logan* & Crowley, 1978; Johnson, 1959; Rogers, 1970). History Alison J. Tierney* provides evidence of the consensus that was reached, and Ida Jean Orlando Pelletier 1926–2007 nursing doctoral programs began to open to generate *Roper, Logan, and Tierney collaborated on The Roper-Logan- nursing knowledge. Tierney Model of Nursing. The 1970s was a significant period of development. In 1977 after the journal Nursing Research had been pub- lished for 25 years, studies were reviewed comprehensively text are referred to their original publications. Nursing and their strengths and weaknesses reported. Batey (1977) theoretical works represent the most comprehensive presen- called attention to the importance of nursing conceptual- tation of systematic nursing knowledge and are therefore ization in the research process and the role of a conceptual vital to the future of both the discipline and the profession framework in research design for the production of sci- of nursing. ence. This emphasis led to the theory development era and moved nursing forward to new nursing knowledge for SIGNIFICANCE OF NURSING THEORY nursing practice. Soon nursing theoretical works began to be recognized to address Batey’s call (Johnson, 1968, 1974; At the beginning of the 20th century, nursing was not King, 1971; Levine, 1969; Neuman, 1974; Orem, 1971; recognized as an academic discipline or a profession, but Rogers, 1970; Roy, 1970). In 1978 Fawcett presented the accomplishments of the past century led to recogni- her double helix metaphor, now a classic publication, tion of nursing in both areas. The terms discipline and clarifying the interdependent relationship of theory profession are interrelated, and some may use them inter- and research. Also at this time, nurse scholars such as changeably; however, they are not the same. It is impor- Henderson, Nightingale, Orlando, Peplau, and Wiedenbach tant to note their differences and specific meaning, as were recognized for the theoretical nature of their earlier presented in Box 1.2. writings. These early works were developed by educators as frameworks for nursing practice or to structure curric- ulum content in nursing programs. Orlando’s (1961, 1972) theory was derived from the report of an early BOX 1.2 The Meaning of a Discipline nationally funded research project that was designed to Versus a Profession study nursing practice. A discipline is specific to academia and refers to a At the Nurse Educator Nursing Theory Conference in branch of education, a department of learning, or a New York City in 1978, the theorists were brought together domain of knowledge. on the same stage for the first time, although most of them A profession refers to a specialized field of practice, denied they were theorists, and understanding of the sig- founded on the theoretical structure of the science or nificance of the works for nursing was limited at the time. knowledge of that discipline and accompanying prac- Also noteworthy at this time, Donaldson and Crowley tice abilities. (1978) presented the keynote address at the Western Com- Data from Donaldson, S. K., & Crowley, D. M. (1978). The mission of Higher Education in Nursing Conference in discipline of nursing. Nursing Outlook, 26(2), 1113–1120; 1977, just as the nursing doctoral program at the Univer- Orem, D. (2001). Nursing: Concepts of practice (6th ed.). sity of Washington was about to open. They discussed the St Louis: Mosby; Styles, M. M. (1982). On nursing: Toward a nature of nursing science and the nature of knowledge new endowment. St Louis: Mosby. needed for the discipline and the profession. The published  CHAPTER 1 Introduction to Nursing Theory: Its History and Significance 7 version of their keynote address remains a classic for stu- their practice. Kuhn (1970), noted philosopher of science, dents to learn the difference between the discipline and the stated, “The study of paradigms... is what mainly profession of nursing. They called for both basic and ap- prepares the student for membership in the particular plied research, asserting that each type of knowledge was scientific community with which he [or she] will later vital to nursing as a discipline and as a profession. They practice” (p. 11). This is significant for all nurses, but it is argued that the discipline and the profession are inextrica- particularly important to those who are entering the pro- bly linked, but failure to separate them from each other fession because “in the absence of a paradigm... all of the anchors nursing in a vocational rather than a professional facts that could possibly pertain to the development of a view. The current development of Doctor of Nursing Prac- given science are likely to seem equally relevant” (Kuhn, tice (DNP) programs, not to be confused with nursing 1970, p. 15). Finally, with regard to the priority of para- research Philosophy Doctorates (PhD), is apropos to their digms, Kuhn (1970) states, “By studying them and by point. practicing with them, the members of their corresponding Soon nursing conceptual frameworks began to be used community learn their trade” (p. 43). Master’s and Doctor to organize curricula in nursing programs and were recog- of Nursing Practice (DNP) students apply and test theo- nized as models that address the values and concepts retical knowledge in nursing practice. Doctoral (PhD) of nursing. The creative conceptualization of a nursing students studying to become nurse scientists develop metaparadigm (person, environment, health, and nursing) nursing theory, test theory, and contribute nursing science and a structure of knowledge clarified the related nature of in theory-based and theory-generating research studies the collective works of major nursing theorists as concep- (Grace et al., 2016). tual frameworks and paradigms of nursing (Fawcett, 1984). This approach organized nursing works into a system of Significance for the Profession theoretical knowledge, developed by theorists at different Not only is theory essential for the existence of nursing as times and in different parts of the country. Each nursing an academic discipline, it is also vital to the practice of conceptual model was classified on the basis of a set of professional nursing (McCrae, 2012). Recognition as a analysis and evaluation criteria (Fawcett, 1984, 1993). Rec- profession seemed to be a less urgent issue as the 20th ognition of the separate nursing works collectively with a century ended because of consistent progress in the nurs- metaparadigm umbrella enhanced the recognition and ing theory era to solidify professional status. Nursing is understanding of nursing theoretical works as a body of recognized as a profession today because its development nursing knowledge. In short, the significance of theory for was guided by the criteria for a profession. Bixler and the discipline of nursing is that the discipline is dependent Bixler (1959) published a set of criteria for a profession on theory for its continued existence—that is, nursing can tailored to nursing in the American Journal of Nursing be a vocation, or nursing can be a discipline with a profes- (Box 1.3). These criteria have historical value for enhanc- sional style of theory-based practice. The theoretical works ing our understanding of the developmental path that have taken nursing to higher levels of education and prac- nurse leaders followed. For example, a knowledge base tice as nurses moved from the functional focus, with an that is well defined, organized, and specific to the disci- emphasis on what nurses do, to a patient focus, emphasiz- pline was formalized during the last half of the 20th ing what nurses know for thought, decision making, and century. And this knowledge is not static; rather, it con- action. tinues to grow in relation to the nursing profession’s goals Frameworks and theories are structures about human for the human and social welfare of the society. Theories beings and their health; these structures provide nurses and research are vital to the discipline and the profession, with a perspective of the patient for professional practice. so that new theory-based knowledge continues to be gen- Professionals provide public service in a practice focused erated (Grace et al., 2016; McCrae, 2012). The application on those whom they serve. The nursing process is useful in of nursing knowledge in practice is the criterion for a practice, but the primary focus is the patient, or human profession that is currently at the forefront, with empha- being. Knowledge of persons, health, and environment sis on quality, accountability, theory-based or informed forms the basis for recognition of nursing as a discipline, evidence, and recognition of middle-range theory for and this knowledge is taught to those who enter the pro- professional nursing practice (Alligood, 2014). fession. Every discipline or field of knowledge includes In the last decades of the 20th century, in anticipation theoretical knowledge. Therefore nursing as an academic of the new millennium, ideas were targeted toward mov- discipline depends on the existence of nursing knowledge ing nursing forward. Styles (1982) called for a distinction (Alligood, 2011a; Grace et al., 2016; McCrae, 2012). For between the collective nursing profession and the indi- those entering the profession, this knowledge is basic for vidual professional nurse and for internal developments 8 UNIT I Evolution of Nursing Theories BOX 1.3 Criteria for Development discipline and their contributions to the health of of the Professional Status of Nursing society. Finally, the continued recognition of nursing theory 1. Utilizes in its practice a well-defined and well-organized as a tool for reasoning, critical thinking, and decision body of specialized knowledge [that] is on the intellec- making is required for quality nursing practice. Profes- tual level of the higher learning sional nursing practice requires a systematic approach 2. Constantly enlarges the body of knowledge it uses that is focused on the patient, and the theoretical works and improves its techniques of education and service provide perspectives of the patient. The theoretical works through use of the scientific method presented in this text illustrate those various perspec- 3. Entrusts the education of its practitioners to institu- tives. Philosophies of nursing, conceptual models of tions of higher education nursing, nursing theories, and middle-range theories 4. Applies its body of knowledge in practical services provide the nurse with a view of the patient and a guide vital to human and social welfare for data processing, evaluation of evidence, and deci- 5. Functions autonomously in the formulation of profes- sions regarding actions to take in practice (Alligood, sional policy and thereby in the control of professional 2014; Butts & Rich, 2011; Chinn & Kramer, 2015; activity Fawcett & Garity, 2009; Masters, 2015). Globally, nurses 6. Attracts individuals with intellectual and personal have recognized the rich heritage of the works of nursing qualities of exalting service above personal gain who theorists; that is, the philosophies, conceptual models, recognize their chosen occupation as a life work theories, and middle-range theories of nursing have 7. Strives to compensate its practitioners by providing become more and more numerous in the nursing litera- freedom of action, opportunity for continuous profes- ture worldwide. The publication of this text in multiple sional growth, and economic security (at least 10) languages also reflects the global use of Data from Bixler, G. K., & Bixler, R. W. (1959). The professional theory. The contributions of global theorists present status of nursing. American Journal of Nursing, 59(8), nursing as a discipline and provide a knowledge struc- 1142–1146. ture for further development. Theory-based research contributes to evidence-based practice. That is, when nursing theory-based research is supported, it informs based on nursing ideals and beliefs for continued profes- evidence. There is worldwide recognition of the rich di- sional development. Similarly, Fitzpatrick (1983) pre- versity of nursing values represented in nursing models sented a historical chronicle of 20th-century achievements and theories. Today we see added clarification of the that has led to the professional status of nursing. Both theoretical works in the nursing literature as more and Styles (1982) and Fitzpatrick (1983) referenced a detailed more nurses learn and use theory-based practice. The history specific to the development of nursing as a profes- philosophies, models, theories, and middle-range theo- sion. With recognition of nursing as a profession, empha- ries are used broadly in all areas—nursing education, sis in this text is on the relationship between nursing theo- practice, research, and administration. McCrae (2012) retical works and the status of nursing as a profession. argues that nursing theoretical knowledge takes on Similarities and differences may exist in sets of criteria greater importance, because evidence-based practice and to evaluate professions, but they all call for a body of multidisciplinary health care require nurses to articulate a knowledge that is foundational to the practice of the given sound basis for their contributions to other professionals. profession (Styles, 1982). The theoretical works exhibit the criteria for normal sci- As individual nurses grow in their professional status, ence (Kuhn, 1970; Wood, 2014). The scholarship of the past the use of substantive knowledge for theory-based evi- 5 decades has greatly expanded the volume of nursing litera- dence for nursing is a quality that is characteristic of ture around the philosophies, models, theories, and middle- their practice (Butts & Rich, 2011). This commitment to range theories. In addition, the philosophy of science for theory-based evidence for practice is beneficial to pa- nursing knowledge development has expanded with new tients in that it guides systematic, knowledgeable care. It research approaches. More and more nurses are acquiring serves the profession as nurses are recognized for the higher education and understanding the value of nursing contributions they make to the health care of society. As theory. The use of theory amplifies knowledge development noted previously in relation to the discipline of nursing, and enhances the quality of nursing practice (Alligood, the development of knowledge is a vital activity for nurse 2011a, 2011b, 2014; Chinn & Kramer, 2015; Fawcett & scholars to pursue. It is important that nurses have Garity, 2009; George, 2011; Grace et al., 2016; Im & Chang, continued recognition and respect for their scholarly 2012; McCrae, 2012; Reed & Shearer, 2012; Wood, 2014).  CHAPTER 1 Introduction to Nursing Theory: Its History and Significance 9 S U MMA RY This chapter has introduced the vital nature of nursing data quickly, decide on appropriate nursing action, theoretical knowledge from the perspective of its history deliver care, and evaluate outcomes but also discuss the and significance. History traces the progression toward nature of their practice clearly with other health profes- professional status with a focus on development of sionals, which is vital for nurse participation in interdis- knowledge on which to base nursing practice and verifies ciplinary care. Finally, considering nursing practice in a that nurses increase their professional power when using theory context for education helps students develop ana- systematic theoretical evidence for critical thinking and lytical skills and critical thinking ability as they clarify decision making (McCrae, 2012). The significance of their values and assumptions. Theory guides education, nursing theory is verified as nurses use theory and theory- practice, research, and administration (Alligood, 2014; based evidence to structure their practice and quality Chinn & Kramer, 2015; Fawcett & DeSanto-Madeya, of care improves. They are able to not only sort patient 2012; Meleis, 2012). POI NTS FOR FURTH ER STU DY Donaldson, S. K., & Crowley, D. M. (1978). The disci- The Nursing Theory Page at Hahn School of Nursing, Univer- pline of nursing. Nursing Outlook, 26(2), 1113–1120. sity of San Diego. Retrieved from http://www.sandiego.edu/ Fawcett, J. (1984). 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Wood, A. F. (2014). Nursing models: Normal science for nursing Philadelphia: Lippincott Williams & Wilkins. practice. In M. R. Alligood (Ed.), Nursing theory: Utilization Nicoll, L. (1997). Perspectives on nursing theory (3rd ed.). & application (5th ed., pp. 13–39). St Louis: Mosby-Elsevier. Philadelphia: Lippincott Williams & Wilkins. Hildegard E. Peplau Virginia Henderson Faye Glenn Abdellah 1909–1999 1897–1996 1919–Present Ernestine Wiedenbach Lydia Hall Joyce Travelbee 1900–1996 1906–1969 1926–1973 Kathryn E. Barnard Evelyn Adam Nancy Roper 1938–2015 1929–Present 1918–2004 11  2 Winifred W. Logan Alison J. Tierney Ida Jean (Orlando) Pelletier 1931–2010 1926–2007 Nursing Theorists of Historical Significance Marie E. Pokorny* “The idea of nursing, historically rooted in the care of the sick and in the provision of nurturance for those vulnerable to ill health, is foundational to the profession.” (Wolf, 2006, p. 301) This chapter presents selected theorists noted for develop- HILDEGARD E. PEPLAU ing nursing theoretical works during the preparadigm pe- riod and for making important early contributions to the Theory of Interpersonal Relations development of specialized nursing knowledge. National Hildegard E. Peplau has been described as the mother of health sociological studies recommended that nursing be psychiatric nursing because her theoretical and clinical developed as a profession (Ervin, 2015), and, as presented work led to the development of the distinct specialty field in Chapter 1, a body of specialized knowledge was required of psychiatric nursing. Her scope of influence in nursing for nursing to be recognized as such. Ultimately criteria for includes her contributions as a psychiatric nursing expert, a profession were tailored to nursing, and guidance was educator, author, and nursing leader and theorist. provided in the process. One criterion that called for spe- Peplau provided major leadership in the professionaliza- cialized nursing knowledge and knowledge structure tion of nursing. She served as executive director and presi- served as an important driving force throughout the 20th dent of the American Nurses Association (ANA). She century (Bixler & Bixler, 1959). The criterion reads: was instrumental in the 1980 ANA definition of nursing that was nursing’s declaration of a social contract with Utilizes in its practice a well-defined and well-organized society in Nursing: A Social Policy Statement (Butts & Rich, body of specialized knowledge [that] is on the intellectual 2015). She promoted professional standards and regulation level of the higher learning (p. 1143). through credentialing. Peplau taught the first classes for graduate psychiatric nursing students at Teachers College, Photo Credit (Joyce Travelbee): Louisiana State University Health Columbia University, and she stressed the importance of Sciences Center, School of Nursing, New Orleans, LA. nurses’ ability to understand their own behavior to help *Previous author: Ann Marriner Tomey others identify perceived difficulties. Her seminal book, 12  CHAPTER 2 Nursing Theorists of Historical Significance 13 Interpersonal Relations in Nursing (1952), describes the im- Peplau had professional relationships with others in portance of the nurse-patient relationship as a “significant, psychiatry, medicine, education, and sociology that influ- therapeutic interpersonal process” (p. 16) and is recognized enced her view of what a profession is and does and what as the first nursing theory textbook since Nightingale’s it should be (Sills, 1998). Her work was influenced by work in the 1850s. She discussed four psychobiological Freud’s, Maslow’s, and Sullivan’s interpersonal relationship experiences that compel destructive or constructive patient theories and by the contemporaneous psychoanalytical responses, as follows: needs, frustrations, conflicts, and model. She borrowed the psychological model to synthe- anxieties. Peplau identified four phases of the nurse-patient size her Theory of Interpersonal Relations (Haber, 2000). relationship—orientation, identification, exploitation, Her work on nurse-patient relationships is known well and resolution (Fig. 2.1); diagrammed changing aspects of internationally and continues to influence nursing practice nurse-patient relationships (Fig. 2.2), and proposed and and research. Recent publications using her model include described six nursing roles: stranger, resource person, research on the effect of communication on nurse-patient teacher, leader, surrogate, and counselor (Fig. 2.3). relationships (Arungwa, 2014), observing and analyzing empathy in Brazilian nursing professionals (Trevizan et al., 2015), assisting nursing students to understand holistic communication skills during their encounters with older On admission adults (Deane & Fain, 2016), applying her theory to simu- lation learning in undergraduate nursing students (Searl et al., 2014), illustrating the roles played by nurses caring During intensive for children with complex needs in the home setting in treatment period Orientation Ireland (Doyle & Buckley, 2012), generating best-practice knowledge for working with children of incarcerated par- Identification Convalescence ents (Falk, 2014), describing identity concerns in those and Exploitation who experienced adolescent dating violence (Draucker rehabilitation Resolution et al., 2012), developing a framework to support the evalu- ation of Nurse Practitioner-Aged Care Models of Practice Discharge in Australia (Hungerford, Prosser, & Davey, 2015), describ- ing home health care nurse therapeutic