She was instrumental in ending the abuses of women (e.g., involuntary sterilization) that were occurring within the Indian Health Care System (Scozzari, 2008). The curriculum included knowledge of “the customs and laws of the hospital world which she (student) must be admonished to accept meekly” (p. 136) and “personal virtues of importance such as reticence, tact, and discretion in order that she may do no harm” (p. 136). It was the New York conference that underscored a growing awareness that the nature of knowledge needed for nursing practice was theoretical knowledge. Nurse-scientist programs were established to enable nurses to earn doctoral degrees in other disciplines with the idea that the research skills that were learned could then be applied in nursing. The developments in research influenced nursing education, emphasizing graduate education with nursing research courses. During this era a series of national conferences united nurses to exchange ideas and evaluate knowledge obtained from non-nursing doctoral programs that could address nursing’s knowledge-building needs. METHODS: A prospective cohort study analyzing the effect of a knowledge to action (KTA) education plan on nursing compliance with ERAS protocols was conducted on bedside nursing staff caring for the colorectal ERAS post-operative population using a new test instrument for pre- and post-testing. The fundamental importance of personal knowledge is acknowledged in that “only when a person is something to herself can she become anything to anybody else” (p. 741). Experience was seen as important to the development of aesthetic knowing. Mother of modern nursing. This movement toward professionalism provides a context to understand the eras as nursing’s march toward achievement of a body of nursing knowledge. Author information: (1)School of Nursing and Midwifery, University of Brighton, Eastbourne, UK. As academically based nurses gained skills in the methods of science, conceptual frameworks and other types of theoretic writings began to emerge. Kinloch, a Scottish physician and Chief of the Department of Health in Scotland, echoes Dock when he notes that “were our efforts unified . As Oettinger (1939) put it, such a nurse is “free from conscript minds giving conscript thoughts” and is “free to change the status quo” (p. 1244). For our purposes, the term modern nursing refers to nursing that came after the work of Nightingale. Selection of nursing education programs for potential students was difficult at this time. The early religious orders offered a respectable avenue for nuns and monks to provide care to the ill and infirm. ERAS UK is the British Section of the International Society of Enhanced Recovery After Surgery. Only three nursing doctoral programs existed at the beginning of this era, and the federally funded programs established in the 1950s as a result of the post–World War II shortage of nurses were still in place. Gregg also redefined virtue as “the inner life as well as the outer in consistency of behavior with one’s own thoughts and feelings” (p. 740) and further stated that “motives and conduct must harmonize” (p. 740). Indeed, education was counterproductive for women who, as nurses, were expected to follow orders and serve the needs and interests of physicians when it came to providing care (Melosh, 1982; Reverby, 1987a, 1987b). Learning how to conduct research was encouraged for nurses, and they welcomed new contributions to this body of knowledge. Nursing followed a path from concepts to conceptual frameworks to models to theories, and ﬁ nally to middle range theory, in this theory utilization era. In summary, the early periodical literature reflects a view of ethical behavior and comportment as conforming to individual virtues. . Nightingale also had a great influence on nursing education; she founded St. Thomas School in London after her return from the Crimea. CONCLUSIONS: The improvement in test scores indicates nursing knowledge regarding care of HPB patients increased after attending the course. Knowledge Development The focus for knowledge development in nursing has roots in Nightingale's 1859 essay, Notes on Nursing: What It Is and What It Is Not.3 She wrote, "The very elements of what constitutes good nursing are as little understood for the well as for the sick. Welcome to the Nursing and Allied Health Professional Group. Broader goals also were mentioned, such as increasing tolerance and respect by respecting the worth, autonomy, and dignity of individuals; assisting with the development of the individual; strengthening society and the Self; developing economic security; and promoting peace. Mabel Staupers worked for improved access to equitable health care services for African American citizens (American Nurses Association, 2009a). Table 1-1 summarizes nursing’s search for specialized knowledge. Her primary concern was the more pervasive plight of Victorian women. What curriculum content should student nurses study? Women in her era were poverty stricken and forced to work at menial labor for long hours for little or no pay, or else they were—as was the case with Nightingale—idle ornaments in the households of wealthy husbands or fathers. . Two important trends are (1) the use of theories that have been borrowed from other disciplines, and (2) the development of conceptual frameworks that define nursing. It was also noted that the research focused on nurses or student nurses rather than patients. Students also learned proper techniques of nursing. During the junior year, ethics would cover “handling of supplies and appliances, avoiding accidents, use of good surgical technique, wise use of recreation and holidays, and the necessity of a good conscience” (p. 137). Because she was firmly committed to the idea that nursing’s responsibilities were distinct from those of medicine, Nightingale maintained that the knowledge developed and used by nursing must be distinct from medical knowledge. Although nurses contributed some of these early writings, other pieces were written by physicians and non-nurse educators and published in nursing journals and books or presented to nursing audiences. The shift toward a concept of nursing knowledge as predominantly scientific began during the 1950s and took a strong hold during the 1960s. According to Pfefferkorn, a scientific attitude was important. (1932, p. 714). . The general level of understanding was such that some thought just by conducting research, the body of knowledge would be formed as a basis for practice. The unit educator grades all tests, compares test results, and evaluates course data to assess effectiveness of education provided to nursing staff. the first and most powerful influence upon human minds is the unconscious operation of social custom . Normal schools were established for the training of teachers and nursing schools were available for training nurses, but, to obtain long-term security, women were required to conform to the role of wife or daughter. Ethics requires “careful investigation, open-minded judgment, the practice of reasonableness and intelligent doubting” (p. 1085). Early in the twentieth century nurses recognized the need to establish nursing as a profession and began the transition from vocation to profession (Alligood, 1997, 2010; Judd, Sitzman, & Davis, 2010; Kalisch & Kalisch, 2004; Meleis, 2007; Rogers, 1961). The discipline of nursing is indebted to those scholars who maintained a focus on the art of nursing as science gained popularity (Judd, et al., 2010; Kalisch & Kalisch, 2004). Such an attitude questions the establishment of rules as the basis for biomedical ethics and validates a relational perspective for ethical conduct. Genevieve and Roy Bixler (1945), two doctorally prepared educators, addressed the development of empirics and wrote “the elements of science should be defined and organized, gathered from every science contributing to nursing and arranged in the most convenient order for thought” (p. 730). She campaigned actively for changes in labor laws that would benefit women and children. Despite the lively debates and substantive issues focused on scientific knowledge, the idea that nursing requires the development of a broad knowledge base that includes all patterns of knowing has never been lost. after one has worked for a time healing wounds which should not have been inflicted, tending ailments which should not have developed, sending patients to hospitals who need not have gone if their homes were habitable, and bringing charitable aid to persons who would not have needed it if health had not been ruined by unwholesome conditions, one longs for preventive work . The Clinical Nurse Leader (CNL) is optimally suited for identification of perioperative barriers for the implementation of ERAS as … 1879 – Mary Eliza Mahoney, the first African-American trained nurse, graduated from the New England Hospital School of Nursing. a casual interlude . Allen Gregg, a physician and Director of Medical Sciences at the Rockefeller Foundation, attributed injustices to “envy and malice and hate and violence” (1940, p. 738). The then-current emphasis on systems theories is evident in the work of Callista Roy, Imogene King, Dorothy Johnson, and Betty Neuman. The emergence of chronic disease with the control of communicable disease and a focus on wholism is reflected in Myra Levine’s conservation principles framework as well as in Dorothea Orem’s theoretic writings on self-care. Praxis is descriptive of knowledge-guided action and action-guided theory (Chinn & Kramer, 2011; Kagan, 2009; Kilpatrick, 2008). . Research Era: The 1950s and the 1970s The value of research in nursing was recognized essential towards a substantial body of knowledge. These nurses apparently recognized the importance of acting in relation to the needs of others while understanding that effective change must come from a grassroots position. This system provided the context for rapid technologic development and a complex institutionalized system to support medical interventions. After they were trained for nursing in hospital schools, many found themselves without employment as new student recruits filled available staff positions. Margaret Sanger, Lillian Wald, Lavinia Dock, Susie Walking Bear Yellowtail, Mabel Staupers, and Adah Thoms are among those nurses who were challenged by specific needs in society and set about to change problematic practices that affected health care. These experiences cultivated and required a broad view of nursing knowledge and a desire to change the future of nursing. Dealing with this question was a major turning point in nursing history regarding graduate nursing education because it led to the realization that the nature of knowledge needed for nursing practice was nursing knowledge. As the beginning of the twentieth century drew near, nurses began to express the need for communication with other nurses to improve their practice. Quality care is a prominent theme in Institute of Medicine reports, health care regulatory policies, the call for nursing education reform, and nurse researchers themselves (, Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), on The Nature of Knowledge Needed for Nursing Practice, Nurse Educator conferences in Chicago (1977), Nursing Philosophies, Models, and Theories: A Focus on the Future, Areas for Further Development of Theory-Based Nursing Practice, Philosophies, Models, and Theories: Critical Thinking Structures, Newman’s Theory of Health as Expanding Consciousness in Nursing Practice, Orem’s Self-Care Deficit Theory in Nursing Practice, Nursing Models: Normal Science for Nursing Practice, Levine’s Conservation Model in Nursing Practice, Nursing Theory Utilization Application 5e. . They were women of strong personal character who lived their ethical convictions that nurses can and should control nursing practice. Because most nursing service was provided as free labor by students in hospitals, those who graduated secured jobs as independent practitioners who were engaged by families to assist with the care of the sick in homes and hospitals. Principles, facts gleaned from observation, and procedural guides for action were important forms of empirics that were necessary for completing the routine hygienic care of patients as well as delegated medical tasks. For example, Sanger developed knowledge about reproduction and birth control. Katherine McClure, a nurse professor, noted the need to “improve the environment and conditions of the persons she nurses without remaking them to suit ourselves” (1951, pp. Despite the value of science, this physician also emphasized the importance of a central focus on the welfare of the patient. For example, nurses recognized that young children needed the continuing love and support of their parents and families during hospitalization. An examination of nursing literature published before the 1950s is rich with detail about how nursing embodies, reflects, and requires multiple ways of knowing. The nursing process replaced the rule- and principle-oriented approaches that were grounded in a medical model in which the nurse functions as a physician’s assistant. Despite strong leaders who followed the Nightingale tradition and who viewed nursing knowledge as unique, nursing knowledge has not always been regarded as distinct from medicine. Economic independence for women in the United States was not possible until the mid-1900s. Theory is not just to know but is to use. With the boom of the industrial age, hospital training schools flourished as America grew, and the curriculum era of the 1900s to the 1940s followed (Judd, et al., 2010; Kalisch & Kalisch, 2004). Factors are emphasized within each era of this brief history that contributed to progress toward substantive knowledge and recognition of nursing as a discipline and a profession. Browse. Formal observation was also established as a valued technique and a skill that was critical for the development of nursing empirics. . Doctoral education in nursing began to flourish, and by the late 1970s, 21 nursing doctoral programs existed and several more universities indicated intent to develop programs. (p. 1087). Early during the 1900s, the Nightingale era was ending, and medical care was taking shape as a science. Despite Nightingale’s insistence that nurses rather than hospital administrators or physicians control nursing care, many circumstances came together in opposition to her model for schools of nursing in the United States. This literature is replete with directives for nursing actions required to rectify societal injustices and conditions that privilege one group over another. He stated: “The service of the learned professions does not bear measuring while it is being rendered” (p. 901). It has been reported that the absence of structure (framework) to specify outcomes creates the risk of a deficit in quality patient care and hampers the growth of nursing science (Conn, et al., 2008; Fawcett & Garity, 2009; Pearson, et al., 2007). Conrad (1947) stated that the art of nursing included such things as “knowing what the patient wants before she is asked” (p. 162). It is our communication skills that enable us to use our knowledge for the benefit of patients… Fundamental differences in viewpoints regarding nursing science provided nurse scholars with the opportunity to learn, to sharpen critical-thinking skills, and to acquire knowledge about the processes and limitations of science. protection, truth telling, and imparting specialized knowledge (. The general understanding that a group of related concepts is a theory or that theory derives from a conceptual framework came later. the severity of the illness does not determine this. a chain around another’s neck means there is a chain about your own . In some societies, people who were being punished for civil offenses, people who were homeless and needed shelter, people who were addicted to drugs and alcohol, and women who were prostitutes also provided nursing care. According to Conrad, art depends on imagination and resourcefulness and requires “true perspective” (pp. Searching for specialized nursing knowledge led nurse scholars to theories that guide research, education, administration, and professional practice. As psychologic theories of attachment and separation developed, nurses found an explanation for the problems experienced by hospitalized children and were able to change visitation practices to provide for sustained contact between parents and children. a whole host of personal attributes that go beyond virtuous behavior, including self-discipline, knowledge of the Self, and an openness to the processes of reflection to create actions with integrity are basic to good nursing care. It was the 1st school of nursing that provided both theory-based knowledge and clinical skill building. 221-222), whereas nurse Janet Geister wrote that “the real wisdom of human life is compounded out of the experiences of ordinary men” (1937, p. 261). Experiences of nursing practice with holistic nursing frameworks led to in-depth understanding of the theories and their utility for practice. Instruction in Nightingale schools emphasized the powers of observation, the necessity of recording observations, and the potential for organizing the nursing knowledge that was gained through such observation and recording. Personal integrity, honesty, enthusiasm, versatility, courageousness, stability, and emotional diversity were important features of personal knowledge. The practitioner who had a sincere intentionality and the ability to carry out sophisticated assessment could act artfully. The novice nurse acquired knowledge of what was right and wrong in practice by observing more experienced practitioners and by memorizing facts about the performance of nursing tasks. The American Nurses Association (ANA) set forth the need for nursing theory development in 1965; however, there were various perceptions among nursing leaders as to what that meant because most had advanced degrees from various disciplines and perspectives of knowledge and theory. Dock was an ardent suffragist and pacifist who worked for much of her professional life with Wald at the Henry Street Settlement. It also addresses how societal values and resources operate to create nursing’s history. How injustices are created is embedded in an eloquent quote from Lavinia Dock (1902-1903), who noted the following in an early issue of American Journal of Nursing: . . Reference to the art of nursing was common in this era. The task of embracing this new content was so great that rather than being a means to an end it often became an end in itself. As the 21st century approached, nurses gave serious attention to wholistic approaches in practice and in the methods used for the development of knowledge. They observed the circumstances of people in their work environment, identified health-related needs, and worked with others to meet those needs. 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