In biblical times, female members of societies were responsible for caring for ill. There was neither organized care, nor science behind the methods of caring: the approaches were passed among the women and were centered on their religious views on sickness and health. The people who provided care were untrained and often belonged to the lowest economic classes, such as slaves. The first organized groups who performed nursing care were male nursing orders in 1300s, such as the Knights of St. John of Jerusalem (Anderson, 1981).
During the 16th and 17th century, nursing jobs fell into “dark ages” becoming synonymous with alcoholism, prostitution, and the waste of society (Anderson, 1981, p. 20). The first nursing school, the Deaconess School of Nursing at Kaiserwerth, Germany was established in 1836. Physicians instructed nursing students about bedside care and how to provide nursing care (Anderson, 1981). The development of nursing science is traced back to Florence Nightingale, whose initial study “Notes of Nursing” (1859) represents the first nursing theory (George, 2011). Nightingale supported her nursing experiences with statistical data.
Nightingale’s analysis of the positive impact of a clean environment on decreasing morbidity and mortality among the soldiers during the Crimean War became the model for changing the nursing practice from an art to a combination of art and science (Burns, Grove, 2007). Nightingale established nursing program at St. Thomas Hospital in London that correlate nursing theory and practice. This school became a model for nursing education. The medicine continued to provide nursing guidelines and influenced nursing practice. The nurses remained relegated to the status of obedience servant to the authoritarian doctors.
The nurses were obligated to obey the physician’s orders faithfully, “never be guilty of making suggestions to the doctor,” since “she [nurse] is there to carry out his [physician] orders” (Walker & Holmes, 2008, p. 111). The lack of preparation and education among the nurses was obvious. Universities began establishing nursing programs throughout the United States. The University of Texas (1894), the Columbia University (1899), the University of Minnesota (1908), and others opened schools of nursing (Anderson, 1981). In 1923, Teachers College at Columbia University offered the first educational nursing program at doctorial level.
The first master’s degree in nursing was established in 1929 at Yale University (Burns & Grove, 2007). During the 1940s, the nursing literature continued to emphasize the practical skills of the nursing. Most of the existing manuals viewed nursing as “the hand” and medicine as “the head as its primary signifier” (Walker, Holmes, 2008, 114). In 1950s, the first nursing theorists were graduates from the Columbia University’s Teachers College educational programs. Their theories were based on practical nursing. The focus of these theories was the patients’ needs.
Peplau (1952/1988) presented interpersonal relations in nursing theory (George, 2011). In 1959, Hall presented care, core, and cure theory, where caring and nurturing for a patient were interconnected with patient’s ability to make decisions of “therapeutic use of self” (George, 2011, p. 183). Many of the nursing leaders in this era recognized that nursing science and theory development were needed to change the status of nursing from a career to a profession (Walker & Avant, 2011). The theories developed during the 1960s focused on the relationships between the nurse and the patient.
The theorists from Yale School, such as Henderson and Orlando, proposed their theories. Henderson in 1960, defined nursing as “assisting” and “help” for the individuals, focusing on the individual plan of care (George, 2011, p. 89). Orlando’s 1961 theory, The Dynamic Nurse-Patient Relationship: Function, Process, and Principles described nursing as an interactive process between the nurse and the individual patient within the immediate situation. Orlando shifted the focus of nursing from assisting the physician to assisting the patient, and promoted the independence of nursing (George, 2011). In 1965, the American Nursing
Association recommended two levels of nursing education, the baccalaureate and the associate, to distinguish the education for a professional nursing from that of the technical nursing profession. During the same time frame, the amount of nursing research was increasing. Nurses became involved in the development of frameworks for nursing practice guidelines (Burns & Grove, 2007). During the 1970s, many nursing theories were revised. Rogers, King, Orem, Neuman, and Watson symbolized this era of nursing theorists. Their theories provided the foundation for the nursing profession, integrating arts, science, and philosophy into nursing.
They focused on human behavior and emphasized the complexity of nursing. The theorists presented the individual as the whole system of the physiological, psychosocial, developmental, cultural, and spiritual elements (George, 2011; Burns & Grove, 2007). The development of the nursing during 1980s was characterized by increased nursing research. Many theories were revised and new theories were proposed. The theories of Erickson, Benner, Leininger, Orem, Roy, King, Watson, Levine, and others represent this era (Burns & Grove, 2007).
The 1990s was characterized by an increasing number of middle range theories that provided guidelines for evidence-based nursing practice. During this time the nursing theories took an international approach with publications and conferences (George, 2011). Throughout the decades, the development of nursing science was influenced by other disciplines, such as religion, philosophy, psychology, anthropology, and social sciences. Religion blamed diseases as a punishment for sins. Philosophy knowledge base of truth, mind, language, and values, widely affected nursing development.
Conceptual models in nursing are the examples of the influence of philosophy on the nursing. For example, Roger’s model explained the nature of the human beings (Burns & Grove, 2007). Watson’s theory reflects philosophical beliefs of caring. Nursing ethics took its origins from the philosophy. Psychology as the study of mind and behavior was used by the nursing theorists. For example, Roy and Roberts (1981) created the theory of adaptation model by deriving it from the psychophysics theory of Helson (1964) (Walker & Avant, 2011). Florence Nightingale ushered in a new era in nursing.