Historical Timeline of Nursing Theory
The evolution of nursing as a profession throughout time has proven to be both an art and science. Different events throughout history have shaped nursing into its current organization. Nursing in the future is improving, striving for better care and service to the community in whole. The objective of this paper is to discuss the historic development of nursing, the relationship of nursing to the profession, and the relationship of nursing science to other disciplines such as religion, education, and psychology.
Florence Nightingale, considered the founder of nursing, corner stoned the impact of nursing as an organized discipline in 1853 (Finklelman, 2013). She posed a systematic approach to nursing, manipulating the internal and external environment to implement benefit the health and facilitates the body’s restorative process (Finklelman, 2013). Moving into the 1950s, Hildegard Peplau uncovered the model that focused on interpersonal relations (Finklelman, 2013).
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The interpersonal relationship revolves around the patient, who has identified problems in which there is a need for nursing care, and the professional nurse, which the care is sought from (Peplau, 1952). Virginia Henderson’s basic needs model that identified 14 basic needs of the whole person. The focus is on developmental, spiritual, physciological, psychological, and socio-cultural needs. To improve health conditions, the nurse, and patient work together by identifying those needs and generating a plan of care to meet the identified needs. Ida Jean Orlandos theory’s foundation is nursing as a discipline.
The patient is an individual with a need. When that need is met, well-being is enhanced therefore diminishing the stressors. Faye G. Abdellah’s 1960s theory emphasizes delivering nursing care to the whole person. The whole person is evaluated by the physical, emotional, intellectual, social factors to include the family, and spiritual needs. Ernestine Wiedenbach prescriptive nursing theory is more of an art. The nurse focuses on observing, exploring the meaning of the symptoms, determines the cause and patient’s ability with or without the intervention of nursing care.
Joyce Travelbee’s interaction-based theory notes the relationship between the nurse and the patient. There are five stages of progress, beginning with the encounter. The relationship further divulges into the identities, developing feelings of empathy, and later feelings of sympathy (George, 2011). In the 1970s, the nursing theories continued to transform. Martha Rogers, Dorothea Orem, Betty Neuman, and Sister Calilista Roy are a few. Martha Rogers sought to promote interaction between human and environmental fields.
To maximize health potential, there is a need for redirection of the environmental fields. This theory focuses on the science of a unitary human being (Finklelman, 2013). One of the most prominent theorists was Dorothea E. Orem, and her self-deficit care theory. Orem (1985) defined health as, “A state characterized by soundness or wholeness of developed human structures and of bodily and mental functioning” (pg. 101). Nursing actions fall into one of three categories: wholly compensatory, partly compensatory, or supportive educative system (Orem, 1985).
Betty Neumans infamous, Neuman systems model, is a composite of variables and their interaction internally and externally with the environment as well as the created environment (Finklelman, 2013). Some factors include physiological, developmental, spiritual, psychological, and sociocultural (Finklelman, 2013). Nursing care focuses on the factors that influence the patient and three levels of prevention (George, 2011). In the 1980s, Dorothy E. Johnson posed a behavioral system model in which there are two major systems within the human being, the biological and behavioral systems.
The focus of medicine is on the biological system whereas the behavioral system is nursing’s focus. There is a direct influence from the patient’s behavior by the environment as well as the events that occur within the environment. The behavioral responses include those such as physical, social, mental, and emotional. The primary goal of nursing care is to foster equilibrium among those systems (George, 2011). Madeline M. Leninger’s theory is one of a transcultural kind. Culture is defined, valued, and practiced, therefore creates a state of well-being (Leininger, 1991).
The nursing care focus is of the congruency of culture and beliefs for creating the plan of care. Patricia Benner posed a moving theory from novice to expert. The movement is evaluated from experiences and principles (Finklelman, 2013). The 1990s have revolved around expansion of theories. Several theorists, such as M. Leninger, D. Orem, C. Roy, and B. Neuman, have revised their theories (George, 2011). The future is leading into diversity and nursing care. The physical practice of nursing as a profession basis is the science of nursing. Theories guide research in nursing as well as the practice.
Depending on the theory applied, depends on the nursing care practiced. There are patient centered care models, science models, interpersonal relationship models, etc. The nursing theories have a base foundation of the core concepts, but some recent theorists think that four concepts is too restrictive (George, 2011). With each break down of a theory, at least one or more of the four original concepts can be seen. Those concepts are person, health, environment, and nursing (George, 2011). There is a global commonality in which nursing care over the course of history has remained consistent.
Nursing science is influential on other disciplines. Assessing patient needs is imperative in psychology, as it is for nursing care in all historical theories. Therapeutic communication and interpersonal relationships are noted in several nursing theories, which relates hugely to the psychological focus of behaviors. Therapeutic communication is essential in forming a plan of care with nursing and psychology. There are several theories that take a whole person concept to include spirituality, cultural diversity as well. M. Leninger is just one theorist who projects a strong spiritual/religious foundation.
Educational needs should be assessed to formulate a plan of care. Nursing has an extensive history with many hardships such as war and plagues. Whether good or bad, the historic events molded nursing into the strong profession and science it is today. The theories throughout history have evolved, each building upon each other with different focuses, resulting in a stable profession that continues to grow. As an interdisciplinary profession, nursing, and ongoing nursing research is essential in the health care system. Nurses have and will continue to be skillfully guided by the historical theories of foundation.
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