SAINT TONIS COLLEGE, INC.

(Formerly: Kalinga Christian Learning Center)

United Church of Christ in the Philippines
Purok 4, Bulanao Centro, Tabuk City, Kalinga
Philippines 3800
Tel. No. (074) 627-5930, Email Address: sainttoniscollege@yahoo.com

LEARNING MODULE-1

COURSE SUBJECT: NCM 100

LEARNING CONTENT: EVOLUTION OF NURSING ( Introduction of Nursing Theory)
LEARNING OUTCOMES: At the end of the topic, the student will be able to:
1.integrate relevant concepts and meta paradigm of theories on person, health, environment and
nursing practice
2.apply appropriate nursing concepts and actions holistically and comprehensively in community setting.

LEARNING DISCUSSION:
A. INTRODUCTION TO NURSING THEORY

This chapter introduces nursing theory from two important perspectives:

history and significance. Each contributes meaning to an understanding of the contributions of the nurse
theorists and their work. A brief history of nursing development from vocational to professional
presents a description of the search for substantive nursing knowledge on which to base nursing
practice. The progressive search ultimately led to this exciting time of theory utilization in nursing
history. The history of this development provides context and perspective to understand the continuing
significance of nursing theory. As nursing advanced, the significance of nursing theory became clear for
both the discipline and profession of nursing.

1.HISTORY OF NURSING THEORY

______________________________________________________________________________
An institution of the United Church of Christ in the Philippines (UCCP)
Member: Association of Christian Schools, Colleges and Universities (ACSCU)
UCCP Church Related Educational Action Towards Empowerment (UCCP CREATE)
Cordillera Schools Group (CSG)
 SAINT TONIS COLLEGE, INC.
(Formerly: Kalinga Christian Learning Center)
United Church of Christ in the Philippines
Purok 4, Bulanao Centro, Tabuk City, Kalinga
Philippines 3800
Tel. No. (074) 627-5930, Email Address: sainttoniscollege@yahoo.com

The history of professional nursing began with Florence Nightingale. Nightingale envisioned nurses as a
body of educated women at a time when women were neither educated nor employed in public service.
After her war-time service of organizing and caring for the wounded in Scutari during the Crimean war,
Nightingale’s vision and establishment of a School of Nursing at St. Thomas’ Hospital in London marked
the birth of modern nursing. Nightingale’s pioneering activities in nursing practice and education and
her subsequent writings became a guide for establishing nursing schools and hospitals in the United
States at the beginning of the 20 century (Judd and Sitzman,2013; Kalish and Kalisch,2003; Nightingale
th

,1859/199).
Nightingale’s vision of nursing has been practiced for more than a century, and theory development in
nursing has evolved rapidly over the past six decades, leading to the recognition of nursing as an
academic discipline with a specialized body of knowledge(Alligood,2014). It was during the mid-1800s
that Nightingale recognized the unique focus of nursing and declared nursing knowledge as distinct from
medical knowledge. She described a nurse’s proper function as putting the patient in the best condition
for nature to act upon him or her. She set forth the following: that care of the sick is based on
knowledge base than that used by physicians in their practice.
Despite this early edict from Nightingale in the 1850’s, it was 100 years later during the 1950’s, when
nursing profession leaders began serious discussion of the need to develop nursing knowledge
continued to grow. Until the proposal of nursing as a science in the 1950’s, nursing practice was based
on principles and traditions that were handed down through an apprenticeship model of education and
individual hospital procedure manuals (Alligood,2014;Kalish and Kalisch 2003). The transition from
vocation to profession is described here in successive eras of history as nurses began developing a body
of specialized knowledge on which to base nursing practice. Nurses began with a strong emphasis on
practice and worked throughout the century toward the development of nursing as a profession.
Progress in each of these eras toward the goal of a specialized basis for nursing practice demonstrates
the seriousness of this drive toward professional development (Alligood,2014).
The curriculum era addressed the question of what content nurses should study to learn how to be a
nurse. During this era, the emphasis was on what courses nursing students should take, with the goal of
arriving at a standardized curriculum (Alligood,2014). By the mid-1930s, a standardized curriculum had
been published and adopted by many diplomas nursing programs, where nursing was taught at that
time. The idea of moving nursing education from hospital-based diploma programs into colleges and
universities began to emerge during this era (Ervin,2015;Judd and Sitzman 2013).
As nurses increasingly sought degrees in higher education, the research emphasis era began to emerge.
During the midcentury more nurse leaders embraced higher education and arrived at an understanding
of the scientific age and that research was the path to new nursing knowledge. Nurses began to
participate in research and research courses were included in nursing curricula in early graduate nursing
programs (Alligood, 2014)
2.SIGNIFICANCE OF NURSING THEORY

______________________________________________________________________________
An institution of the United Church of Christ in the Philippines (UCCP)
Member: Association of Christian Schools, Colleges and Universities (ACSCU)
UCCP Church Related Educational Action Towards Empowerment (UCCP CREATE)
Cordillera Schools Group (CSG)
 SAINT TONIS COLLEGE, INC.
(Formerly: Kalinga Christian Learning Center)
United Church of Christ in the Philippines
Purok 4, Bulanao Centro, Tabuk City, Kalinga
Philippines 3800
Tel. No. (074) 627-5930, Email Address: sainttoniscollege@yahoo.com

At the beginning of the 20 century, nursing was not recognized as an academic discipline or a
th

profession, but the accomplishments of the past century led to recognition of nursing in both areas. The
term discipline and profession are interrelated and some may use them interchangeably; however, they
are not the same. It is important to note their differences and specific meaning.
A DISCIPLINE is specific to academia and refers to a branch of education, a department of learning or a
domain of knowledge.
A PROFESSION refers to a specialized field of practice, founded on the theoretical structure of the
science of knowledge of that discipline and accompanying practice abilities.

SIGNIFICANCE FOR THE DISCIPLINE

When nurses entered baccalaureate and higher-degree programs in universities during the last half of
the 20 century, the goal of developing knowledge as a basis for nursing practice began to be realized.
th

University baccalaureate programs proliferated, master’s programs in nursing were developed, and a
standardized curriculum was realized through accreditation. Nursing had passed through eras of gradual
development, and nursing leaders offered their perspectives on the development of nursing science.
They addressed significant disciplinary questions about whether nursing was an applied science or a
basic science (Donaldson and Crowley,1978) Johnson ,1959; Rogers 1970). History provides evidence of
the consensus that was reached and nursing doctoral programs began to open to generate nursing
knowledge.
The 1970s was a significant period of development. In 1977 after the journal Nursing Research had been
published for 25 years, studies were reviewed comprehensively and their strengths and weaknesses
reported. Batey (1977) called attention to the importance of nursing conceptualization in the research
process and the role of a conceptual framework in research design for the production of science. This
emphasis led to the theory development era and moved nursing forward to new nursing knowledge for
nursing practice. In 1978 Fawcett presented her double helix metaphor, now a classic publication and
research. Also at this time, nurse scholars such as Henderson, Nightingale, Orlando, Peplau, and
Wiedenbach were recognized for the theoretical nature of their earlier writings. These early works were
developed by educators as frameworks for nursing practice or to structure curriculum content in nursing
programs. Orlando’s (1972) theory derived from the report of an early nationally funded research
project that was designed to study nursing practice.
At the nurse educator nursing theory conference in New York City in 1978, the theorists were brought
together on the same stage for the first time, although most of them denied they were theorists, and
understanding of the significance of the works of nursing was limited at the time. Also noteworthy at
this time Donaldson and Crowley (1978) presented the keynote address at the Western Commission of
Higher Education in Nursing Conference in 1977, just as the nursing doctoral program at the University
______________________________________________________________________________
An institution of the United Church of Christ in the Philippines (UCCP)
Member: Association of Christian Schools, Colleges and Universities (ACSCU)
UCCP Church Related Educational Action Towards Empowerment (UCCP CREATE)
Cordillera Schools Group (CSG)
 SAINT TONIS COLLEGE, INC.
(Formerly: Kalinga Christian Learning Center)
United Church of Christ in the Philippines
Purok 4, Bulanao Centro, Tabuk City, Kalinga
Philippines 3800
Tel. No. (074) 627-5930, Email Address: sainttoniscollege@yahoo.com

of Washington was about to open. They discussed the nature of nursing science and the nature of
knowledge needed for the discipline and the profession.

The creative conceptualization of a nursing meta paradigm and a structure of knowledge clarified the
related nature of the collective works of major nursing theorists as conceptual frameworks and
paradigms of nursing (Fawcett,1984). This approach organized nursing works into a system of
theoretical knowledge, developed by theorists at different times and in different parts of the country.
Each nursing conceptual model was classified on the basis of a set of analysis and evaluation criteria.
Frameworks and theories are structures about human beings and their health; these structures provide
nurses with a perspective of the patient for professional practice. Professionals provide public service in
a practice focused on those whom they serve. The nursing process is useful in practice, but the primary
focus is the patient, or human being. Knowledge of persons, health and environment forms the basis
for recognition of nursing as a discipline, and this knowledge is taught to those who enter the
profession. Every discipline or field of knowledge (Alligood,2011a; Grace et al 2017; Mc Crae 2012). For
those entering the profession, this knowledge is basic for their practice. Kuhn (1970), noted philosopher
of science stated. “The study of paradigms….. is what mainly prepares student for membership in the
particular scientific community with which he will later practice.

SIGNIFICANCE FOR THE PROFESSION

Not only is theory essential for the existence of nursing as an academic discipline, it is also vital to the
practice of professional nursing. Recognition as a profession seemed to be a less urgent issue as the 20 th

century ended because of consistent progress in the nursing theory era to solidify professional status.
Nursing is recognized as a profession today because its development was guided by the criteria for a
profession.

B. STRUCTURE OF NURSING KNOWLEDGE

______________________________________________________________________________
An institution of the United Church of Christ in the Philippines (UCCP)
Member: Association of Christian Schools, Colleges and Universities (ACSCU)
UCCP Church Related Educational Action Towards Empowerment (UCCP CREATE)
Cordillera Schools Group (CSG)
 SAINT TONIS COLLEGE, INC.
(Formerly: Kalinga Christian Learning Center)
United Church of Christ in the Philippines
Purok 4, Bulanao Centro, Tabuk City, Kalinga
Philippines 3800
Tel. No. (074) 627-5930, Email Address: sainttoniscollege@yahoo.com

 KNOWLEDGE STRUCTURE LEVELS

STRUCTURE LEVEL EXAMPLES
Meta paradigm Human beings, environment, health and nursing
Philosophy Nightingale’s philosophy
Conceptual Neuman’s systems model
models
Grand theory Neuman’s optimal client stability
Theory Flexible line of defense moderate optimal client stability
Middle-range Maintaining optimal client stability with structured activity in a community setting
theory for healthy aging

 METAPARADIGM
 Originates from two Greek words: META meaning WITH and PARADIGM
meaning PATTERN.
 It is the most global conceptual or philosophical framework of a discipline or
profession.
 It defines and describes relationships among major ideas and values.
 It guides the organization of theories and models for a profession.
 Components of Metaparadigm
1. Person -refers the recipient of nursing care, including physical, spiritual,
psychological, and sociocultural components and can include an individual, family or
community.
2. Environment -refers to all the internal and external conditions, circumstances, and
influences affecting the person.
3. Health -refers to the degree of wellness or illness experienced by the person
4. Nursing- refers to the actions, characteristics and attributes of the individual
providing the nursing care.
 Philosophy is an abstract type that sets forth the meaning of nursing phenomena through
analysis, reasoning and logical presentation.
-define as the science comprising logic, ethics, aesthetics, metaphysics, and
epistemology. It is the “investigation of causes and laws underlying realty” and is inquiry
into the nature of things based on logical reasoning rather than empirical methods.

______________________________________________________________________________
An institution of the United Church of Christ in the Philippines (UCCP)
Member: Association of Christian Schools, Colleges and Universities (ACSCU)
UCCP Church Related Educational Action Towards Empowerment (UCCP CREATE)
Cordillera Schools Group (CSG)
 SAINT TONIS COLLEGE, INC.
(Formerly: Kalinga Christian Learning Center)
United Church of Christ in the Philippines
Purok 4, Bulanao Centro, Tabuk City, Kalinga
Philippines 3800
Tel. No. (074) 627-5930, Email Address: sainttoniscollege@yahoo.com

 Conceptual Model is a paradigm and, therefore, represents a distinctive frame of

reference or context within which the individuals, groups, situations, and events of
interest to a discipline or specialty are viewed.
- Is the synthesis of a set of concepts and the statements that integrate those concepts
into a whole.
- Conceptual models provide structure for a phenomenon, direct thinking, observations
and interpretations and further provide direction for action.
 The grand theory level derives from the conceptual model and proposes an abstract
testable theory. These theories have the capacity to threaten the solvency of the
conceptual model from which they are derived because they test the major premise of the
conceptual model.
 Theory is a conceptual system or framework intended for some purpose.
- It is composed of interrelated concepts, models, and proposition based on
assumptions.
- They provide a framework to develop new and validate current knowledge. They help
to describe, explain and predict to prescribe.
- Defined as an internally consistent group of relational statements (concepts, definition
and proposition) that present a systematic about a phenomenon and which is useful
for description, explanation, prediction and control. (boddy and chitty)
 Nursing theory
 Nursing Theories are used to describe, develop, discriminate and use present
knowledge in nursing.
 A nursing Theory is a set of concept, definition, relationships and assumptions or
propositions derived from nursing models or from other disciplines and project a
purposive, systematic view a phenomena by designing specific inter-relationship
among concepts for the purpose of describing, explaining, predicting or
prescribing.
 Nursing theory is defined as a conceptualization of some aspects of nursing reality
communicated for the purpose o describing phenomena, explaining relationship
between phenomena, predicting consequences or prescribing nursing care.

 Nursing theories provide framework for nurses to systematize their nursing

______________________________________________________________________________
An institution of the United Church of Christ in the Philippines (UCCP)
Member: Association of Christian Schools, Colleges and Universities (ACSCU)
UCCP Church Related Educational Action Towards Empowerment (UCCP CREATE)
Cordillera Schools Group (CSG)
 SAINT TONIS COLLEGE, INC.
(Formerly: Kalinga Christian Learning Center)
United Church of Christ in the Philippines
Purok 4, Bulanao Centro, Tabuk City, Kalinga
Philippines 3800
Tel. No. (074) 627-5930, Email Address: sainttoniscollege@yahoo.com

actions: what to ask? What to observe? What to focus on? What to think about?
 Middle-range theory, has the most specific focus and is concrete in its level of
abstraction. Middle-range theories propose precise testable nursing practice
questions. The specifics in middle-range theories are such things as the age group
of the patient, the family situation, the patient’s health condition, the location of
the patient, and most important, the action of the nurse.

______________________________________________________________________________
An institution of the United Church of Christ in the Philippines (UCCP)
Member: Association of Christian Schools, Colleges and Universities (ACSCU)
UCCP Church Related Educational Action Towards Empowerment (UCCP CREATE)
Cordillera Schools Group (CSG)