CONTACT - Volume 10, Number 1
Graduate Program in Nursing
The Historical Evolution of Our Discipline: Lessons Learned for Graduate Education

Janyce Dyer, DNSc, CRNP, CS
Associate Dean

Meleis (1997) described the evolution of the discipline of nursing as following a unique path with stages that encompassed many milestones. This path can be traced through nursing's tradition in practice, theory, research, and philosophy. The focus of nursing as a scholarly discipline began in practice when Florence Nightingale defined the mission of nursing as providing care to enhance healing and to create a healthy environment. Ms. Nightingale was an expert statistician who inductively arrived at knowledge of persons, health, environment, and professional nursing based on carefully recorded observations. For many years, however, an apprenticeship and service model stifled creativity, development of knowledge, and generation of scholarship. Without a knowledge base of its own, nursing was viewed as a dependent versus independent or interdependent discipline.

During the mid 1950s, changes in the preparation of nurses from diploma training to baccalaureate education translated the "how to" of practice into "what of" academic curriculum. Early graduate programs focused on the functional roles of education and administration. Research focused on studying nursing students and nurses rather than clinical phenomena. This functional orientation helped perpetuate the duality of academics (including science) and practice; academic nurses were far removed from patient care and more interested in theorizing about student learning and curricula; practicing nurses viewed theorizing as an ivory tower detour from clinical problem solving.

Although related more to who we were than what we did, the focus on nursing education and administration led to research related to education and evaluative processes. Objective criteria for research evaluation via peer review were instituted, and rules of the academy (i.e., universality, communality, objectivity, detached scrutiny) became the norm governing nursing science. A major shift in graduate nursing curricula occurred with the introduction of research and statistics courses. This stage made major contributions to scholarship, but in some ways hindered substantive disciplinary knowledge development in nursing.

Influenced by paradigms of other disciplines, the educational background of early nurse theorists and philosophical underpinnings of the 1960s, nursing theories evolved into three general schools of thought: patient needs, nurse-patient interaction, and outcomes of nursing care. Concomitantly, the American Nurses Association identified theory development as a significant goal for the profession, and the National League for Nursing required theory based curricula for accreditation. Thus, emergent theories were used to guide curricula and teaching rather than providing a foundation for practice or research. Theoretical concepts and propositions were not well tested, and scientific energies were initially dissipated. With a shift in research priorities in the 1970s and 80s to clinical phenomena, a more solid commitment to situation-specific theory development emerged. Movement from search for a single theory to guide the discipline to acceptance of the complexity of nursing and the inevitability of multiple theories occurred.

As theory development became more refined, philosophical inquiry became the vehicle with which to understand the premises underlying nursing theory and research. Acknowledging the limitations of existing methods to capture the complexity of nursing phenomena, epistemological discussion focused on the "different ways of knowing," and epistemological diversity became the rule rather than the exception.

The integration of these stages has brought us to the current juncture in our evolution as a scholarly discipline. There is strong consensus that nursing theories and strategies for knowledge development should focus on practice. There has been a shift within nursing toward greater respect and collaboration among clinicians, teachers, administrators, researchers, and theoreticians. Through the integration of theory, research, and practice, masters and doctoral programs across the country are now organized around clinical and substantive areas.

Our history as a discipline has paved the way for where we need to go. We should be moving toward multidisciplinary theories that reflect the situation and experiences of diverse and underserved populations. We should be educating the public regarding the goals and actions of our discipline in order to more effectively influence health and social policy. In knowledge development, academic nurses and researchers should develop stronger partnerships with practicing nurses and clinical agencies. Perhaps the old adage in psychiatric nursing applies to us as a discipline: In order to understand and serve others, we first needed to know and appreciate ourselves.

Meleis, A. I. (1997). Theoretical nursing: Development and progress (3rd ed.). Philadelphia: Lippincott.