Throughout time, nursing has evolved as a profession, combining both art and science. Various historical events have influenced its current structure. Looking ahead, nursing is continuously progressing to enhance care and serve the community better. This paper aims to explore the historical development of nursing, its connection to the profession, and its relationship with other disciplines like religion, education, and psychology.
Florence Nightingale, who is regarded as the founder of nursing, established nursing as a structured field in 1853 (Finklelman, 2013). She introduced a systematic approach to nursing that involved manipulating both the internal and external environment to promote health and aid the body’s healing process (Finklelman, 2013). In the 1950s, Hildegard Peplau developed a model that emphasized interpersonal relationships in nursing (Finklelman, 2013).
The patient and the professional nurse are the central figures in the interpersonal relationship, as identified by Peplau (1952). Virginia Henderson’s model focuses on 14 basic needs that encompass the entire individual, including developmental, spiritual, physiological, psychological, and socio-cultural needs. To enhance health conditions, the nurse and patient collaborate to identify these needs and create a care plan tailored to meet them. Ida Jean Orlando’s theory establishes nursing as a discipline.
The patient is an individual with a need, and meeting that need enhances well-being and reduces stressors. Faye G. Abdellah’s theory from the 1960s emphasizes delivering nursing care to the whole person, evaluating their physical, emotional, intellectual, social, and spiritual needs, including the family. Ernestine Wiedenbach’s prescriptive nursing theory is more focused on the art of nursing, with the nurse observing symptoms, exploring their meaning, determining the cause, and assessing the patient’s ability to manage without nursing intervention.
Joyce Travelbee’s theory focuses on the relationship between the nurse and the patient, emphasizing interaction. The theory describes five stages of progress, starting with the initial encounter. As the relationship evolves, it delves into understanding identities, fostering empathy, and eventually developing feelings of sympathy (George, 2011). In the 1970s, nursing theories underwent further development. Prominent theorists during this time period included Martha Rogers, Dorothea Orem, Betty Neuman, and Sister Calilista Roy. Martha Rogers sought to promote interaction between the human and environmental fields.
To enhance health potential, the environmental fields require redirection, focusing on the science of a unitary human being. Dorothea E. Orem, a notable theorist, developed the self-deficit care theory. According to Orem (1985), health is defined as a state characterized by the soundness or wholeness of developed human structures and bodily and mental functioning (pg. 101). Nursing actions can be classified into three categories: wholly compensatory, partly compensatory, or supportive educative system (Orem, 1985).
Betty Neuman’s well-known Neuman systems model combines variables and their interactions, both internally and externally, with the environment, including the created environment (Finklelman, 2013). These variables encompass physiological, developmental, spiritual, psychological, and sociocultural factors (Finklelman, 2013). Nursing care is centered around the factors impacting the patient and three levels of prevention (George, 2011). Dorothy E. Johnson also proposed a behavioral system model in the 1980s, which identifies two major systems: the biological and behavioral systems within a human being.
The primary focus of medicine is the biological system, while nursing focuses on the behavioral system. The patient’s behavior is directly influenced by the environment and events within it, resulting in various responses such as physical, social, mental, and emotional. The main objective of nursing care is to promote balance among these systems (George, 2011).
Madeline M. Leninger’s theory is a transcultural one that recognizes the significance of culture in defining, valuing, and practicing behaviors that contribute to overall well-being (Leininger, 1991).
The focus of nursing care is on the congruency of culture and beliefs in order to create a plan of care. Patricia Benner developed a theory that describes the progression from novice to expert, which is based on experiences and principles (Finklelman, 2013). The 1990s saw a growth in the expansion of nursing theories, including revisions to theories by M. Leninger, D. Orem, C. Roy, and B. Neuman (George, 2011). The future of nursing care is leading towards diversity. The foundation of the nursing profession is the science of nursing, which is supported by theories that guide both research and practice.
Depending on the theory applied, the nursing care practiced can vary. Several models, such as patient-centered care models, science models, and interpersonal relationship models, are used. The nursing theories are based on core concepts. However, some recent theorists believe that four concepts may be too restrictive (George, 2011). Nevertheless, when breaking down a theory, one or more of the original four concepts can still be observed. These concepts include person, health, environment, and nursing (George, 2011). Throughout history, there has been a global commonality in which nursing care has remained consistent.
Nursing science plays a significant role in various fields. In psychology, the assessment of patient needs is as crucial as it is in nursing care within historical theories. Many nursing theories emphasize therapeutic communication and interpersonal relationships, which are closely related to the psychological study of behaviors. Both nursing and psychology rely on therapeutic communication to develop a comprehensive care plan. Additionally, there are several theories that consider the individual as a holistic entity, incorporating spirituality and cultural diversity. M. Leninger is an example of a theorist who gives great importance to spirituality and religious beliefs.
Educational needs should be evaluated in order to develop a care plan. Nursing has a rich past, marked by challenges like war and plagues. Regardless of positive or negative events, these historical occurrences have shaped nursing into the robust profession and science that it is today. The theories throughout history have progressed, with each one building upon the previous and emphasizing different aspects, ultimately leading to a steady profession that continues to advance. Being an interdisciplinary field, nursing and ongoing nursing research are vital components of the healthcare system. Nurses have always been and will continue to be expertly influenced by foundational historical theories.
References
Finklelman, A. (2013). Professional Nursing Concepts. Burlington, MA: Jones & Bartlett. George, J. B. (2011). Nursing theories: The base for professional nursing practice (6 ed.). Upper Sadle River: Pearson. Leininger, M. (1991). A theory of nursing: Systems, concepts, process. New york: Wiley. Orem, D. E. (1985). Notes on nursing: What it is and what it is no. New York: Dover. Peplau, H. (1952). Nursing science: Major paradigms, theories, and critiques. Philadelphia: Saunders. Rogers, M. E. (1992). Interpersonal relations in nursing. New York: Davis.
