Influence of Historical Events and Nursing Leaders on Nursing Practice
1. Introduction
Contemporary nursing has progressed in complexity and efficacy since the time of Florence Nightingale. Nursing, as a field, has continued to evolve, with growing attention being paid to efficient, patient-centered nursing care. Many factors impact the changes in nursing over the years. The most notable, however, are the influence of historical events and influential nursing leaders on the nursing profession. This essay discusses these two crucial factors that have helped change and mold nursing for the better. First and foremost, historical events have had a profound impact on the nursing profession. Over the years, the nursing profession has gone through many significant changes. Such changes have been spawned and greatly affected by a myriad of historical turning points. As such, by examining the historical events that have shaped nursing and the health care system as a whole, today’s nurses will be better equipped to face the challenges of the future. Well-documented historical events/factors, like epidemics, wars as well as the industrial and technological revolutions, have greatly influenced the nursing profession. Secondly, in order to understand and appreciate the current state of nursing, it is important to recognize the contributions of the women and men who have helped to develop, modernize and revolutionize the nursing field. By incorporating an understanding – we call it nursing history – of related professional nursing, students will have the capacity to appreciate their desire for a college education as well as the relevance of past and present leaders and those historical events that have led to changes in health care. The work of the leaders is to influence change and help others become visionary in what individuals and the nursing profession have to contribute. As will be demonstrated later on in this paper, the leadership and innovative thinking of certain influential nursing leaders have helped to propel the profession to the digital age. With that said, it is also evident that modern nursing, the changes that are witnessed over the years and research have evolved and changed. This is mainly due to contributions by historical nursing leaders. Let’s now examine some of the key historical events that have had a direct and indirect impact on the nursing profession.
1.1. Historical events shaping nursing practice
As colonization of America began, nursing was unorganized and of poor quality. Nursing was not important or respected as a profession. The development of nursing as a profession began with Florence Nightingale. She introduced the Nightingale system of nursing that was based on her ideas of clean and quiet environment, light, ventilation, music and small, family atmosphere with patient care in the home setting. Her ideas are still of crucial value and have remained in the broad scope of the practice of nursing. In 1860, Florence Nightingale founded the Nightingale School of Nursing at St. Thomas’ Hospital in London. This was the first ever nursing school in the world, which opened the doors for nursing to become a profession. Her influence is important in shaping nursing into what it is today. In the 1870s, the Bellevue Hospital School of Nursing in New York City and the Connecticut Training School at the State Hospital in New Britain opened. In 1873, the first three schools in the United States were founded based on the ideas about nursing education that originated at the Nightingale School in London. In 1893, Lillian Wald and Mary Brewster established the Henry Street Settlement in New York as a base for providing city health services. Lillian Wald initiated the idea of public school nursing in New York City in 1902, which led the way for the development of education for school nurses. She was then followed by Lina Rogers who in 1905 was the first nurse employed in a public school and is known as the first school nurse. This marked the beginning of the development of school nursing in the United States. In 1909, the first textbook of nursing for the medical and surgical nurses was published by M. Adelaide Nutting and Lavinia L. Dock. This was the first step towards the definition of advanced nursing practices. Hence, the above events clearly outlined how historical events have shaped nursing practice today. From Florence Nightingale’s influence and the opening of the first ever nursing school in the world in 1860, to the initiation of public school nursing in New York City in 1902, it has marked the development of nursing as a profession and the trend of nursing education. Nowadays, nursing has changed considerably with the expansion of the technological and medical development. Nursing is not limited to the hospital or medical setting but has expanded to many other areas. Nursing practice cannot be really separated from the contribution of the historical events. Different professions have different effects of the historical events. However, it is believed that the history and the historical events that one profession has gone through will set up a milestone for the ongoing development and expansion of the profession in the future. And this can be explicated in the present day of nursing profession.
1.2. Contributions of influential nursing leaders
Many nursing leaders have made their way and they have marked the history of nursing by their work. They have worked upon a set of ideas to promote changes and to improve nursing practice not only for patients and families but also for those working in the field of healthcare such as nurses and healthcare providers. Some of the influential nursing leaders that transformed the nursing practice to an easier and more efficient one that is current in the modern age will be discussed in this section. One of the most influential nursing leaders who has contributed a lot to the nursing practice is Florence Nightingale. She is considered as the pioneer in the theory of nursing. Her work led to significant and lasting improvement in the field of sanitation. She established the first organized school for nursing education and the practices she introduced and taught during her time are the foundation of modern nursing today. In the nineteenth century, nurses were not typically regarded as educated and providing care at the hospitals was a low-status job. Florence Nightingale changed the philosophy of hospital care in the United States. Instead of focusing on the war, she pitched the idea of collecting data and assessing the outcomes of care provided. She also worked on challenges during the change process. It was no surprise that many of her articles and publications were a main source of strength for the nursing leaders who followed her routines. The first steps to start practicing as a nurse is called the Nightingale pledge, which is still recited by nursing graduates in the convocation. This shows how her work and her ideas led to the formation of professional nursing practices and the commitment to the care of the patients, and this pledge is named after her to honor and recognize her contributions to the nursing practice in the whole world today. Some other nursing leaders who made their mark in the history of nursing and healthcare include Diet, Peplau, Nola Pender, Virginia Henderson, and many more. All these nursing leaders had worked on a set of ideas to promote progress, development, or adaptation in nursing. Their work not only made contributions and changes or improvements in patients’ clinical outcomes but also helped shape nursing knowledge at the same time. Their ideas and work had built a productive and effective way of working, which is usually termed as nursing theory. Besides, they also worked to advance the science of nursing, exploring nursing technologies and finding ways to improve the health of the people. For instance, Dorothea Orem was considered a modern nursing theorist. Her self-care deficit nursing theory had influenced most of the nurses in the United States. Her work proposed that patients could recover more quickly and holistically if they were allowed to take care of their own life and undergo treatment under the guidance of a nurse. This has altered the approach in the nursing practice nowadays. Her new theory also opened a path for the new generation by producing evidence that nearly 80% of clinical nurses accept and prefer to use her theory in their practices as it was her theory that inspired them to explore more about the knowledge and practices that can help improve patient outcomes. On the other hand, it also provided the knowledge work basis for the improvements of clinical practices, professional counseling services, and healthcare outcomes as patients’ injury due to inadequate self-care and the burden of illness can now be better prevented and managed under the merits of the scientific research of self-esteem and self-care. Both the work and the knowledge developed by these nursing leaders provide the synergy that will help move the profession of nursing forward. All in all, the impacts of these nursing leaders on knowledge development, clinical practices, and healthcare outcomes are truly immeasurable. And as we know, their work will thread the work and the thoughts of the professionals in the nursing field through times.
2. Nursing Theory in Nursing Practice
A section concentrating on the emphasis of theory in nursing was added to that initial publication. A personal experience demonstrated the need for theoretical structure to support nursing practice in a busy District Nursing Team. When I registered as a District Nurse, it became apparent that it was impossible to log all the patient episodes and all the work that was being done in the time that the early morning staff were getting the notes ready. It was his District Nurse Mentor who verbally said to her, “You’re making effective decisions based on reflection, that’s the sign of a good practitioner.” This led to the initial creation in 1995 of an empirical structure by Claes Wohlin, named by him as the Wohlin Model, specifically created for the hospital environment, and this requires the users to be in a highly computer literate environment. I also trained students and found that at that time nursing education had not made the transfer from a task-driven, doing-structured curriculum to a critical reflective research approach. It appeared that we as mentors were being asked to mentor students based on the assumption that memorizing and time-based immunity of learning results was how the students were to be taught when in fact we all knew that it was neither the reality of the situation of being a student nurse nor was it constructive to our overall aim, which was to produce a well-thought-out independent reflective nurse for the future health service.
2.1. Definition and purpose of nursing theory
Nursing theory can be defined as an organized framework of concepts and purposes designed to guide the practice of nursing. Nursing theories are used to describe, develop, disseminate, and use present knowledge in nursing. Nursing theories and their importance in nursing are looked at. The first one is that nursing theory promotes professionalism within the nursing field. It helps in fostering development in nursing as a profession and as an academic discipline. When nursing knowledge is built on sound theoretical and empirical evidence, it is a step ahead in fostering empowerment. Secondly, theory-based nursing practice gives the certainty that is necessary for effective nursing diagnosis and in the creation of a meaning of nursing treatments and actions. Nursing’s primary commitment is to the recipients of nursing and health care. It involves the promotion of health, the prevention of illness, and the collaboration with clients in their health care endeavors. It provides the basis of understanding the nursing discipline in a more productive way and also helps in the development of future nursing practices. It also promotes the boundaries of nursing’s professional independence, autonomy, and governance. The knowledge offered in nursing theories in many scholarly articles has given the platform for the expansion and growth of the nursing profession in a single general way; to progress nursing as a professional body of information that tries to meet the health desires of society. Nursing theory should provide the principles that underpin practice and help to generate further nursing knowledge. Knowledge advanced from such theoretical work can direct practice and help build nursing science. It is from the evidence of repeated research studies and meta-analysis that knowledge progresses and an essential component to this theory development is the feedback and input of the practicing nurse. This is important to validate the importance of linking knowledge to interdisciplinary health activities and also as a nursing community to direct further nursing research.
2.2. Benefits of incorporating nursing theory into practice
Incorporating nursing theory as a basis for clinical decision-making and integrating these ideals into practice can provide a framework to strengthen the work environment, which encourages staff to collaborate and support each other. However, there are several challenges to be aware of, such as the structure of an organization, when attempting to apply theory to practice. Staff may be expected to comply with certain models of care and work in a task-oriented and physician-centered environment that may not support patient-centered care. For example, a study published in the Journal of Professional Nursing entitled “Nursing theory-guided practice: tailoring strategy” describes a successful plan for implementing a new care delivery model. This project essentially started with the staff and the director of nursing agreeing on a professional practice environment that supports shared leadership, autonomy, and collaborative relationships. The basis of this change was to move away from a physician-centered and task-oriented environment; the environment that the study authors argue many of us have to work in. Instead, the new care delivery model proposed and implemented focused on a patient-centered approach and directing patient care from a role of professional nursing. This particular project emphasizes the fact that if an organization is structured to facilitate an environment guided by a shared nursing theory, quality of care and subsequently patient outcomes may be improved. Horsley (2016) discusses this idea by stating that the relationships created in a nursing environment and the influence of key nursing leaders can often be traced back to the early experiences that nurses have in education and how they in turn are taught to approach care. He goes on to suggest that by utilizing guidelines provided in nursing theory, a more cohesive and effective model of care may be promoted due to the direction and insight it offers. Furthermore, by encouraging continued use of a chosen theory, nurses have the potential to act as valuable means of effecting positive change in the way that a given method of care is executed, thus using theory to inspire and facilitate quality of care and advancement. Adoption of a uniform language that embraces the broad scope of nursing theory and at the same time provides specific direction for nursing care offers the potential for establishing such a professional nursing. By reviewing the literature, correlating research and investigating current practices that have already taken significant steps towards defining the application of nursing theory in a practical manner and incorporating from the current viewpoints offered, an important resource can be established.
2.3. Challenges and criticisms of nursing theory implementation
Nursing theories do not directly give specific solutions; however, they provide a direction in which the nursing practice should go. This is because theory is different from practice as theory is based on the evidence that is present at the time. Therefore, theory can change with times but practice is what it is which is based on each individual nurse’s own personal values and beliefs. This difference has often been a challenge for many nurses to incorporate the use of theory in their practice. However, Zimmermann (91) observes that for a nurse to advance the field and provide quality care, it is necessary to consider and assimilate the available theories in his or her own practice. The writer further notes that one of the main challenges that affect the use of theories in nursing practice is the ability to correctly embrace the use of theory and the duty to act. For example, a patient may present a situation where a nurse has to do something urgently; the nurse may find it challenging to apply the theory that he or she has learned and edited over the years, hence they may tend to act and leave what should have been done according to the theory. Similarly, the confusion between whether something is theory or something is close to practice is another challenge in trying to incorporate the theories in our day to day nursing practice. As experiences show, theory goes further to explain how things work whereas in practice, the tendency of relying on practices that has always been done makes more sense (Laurent and Reeves 894). Another study by Alligood (3) has identified criticism as another substantial challenge in realizing the potential of using nursing theories in practice. She notes that there is a form of authority and power that arise when someone expresses his or her criticism or gives a view against something. This has led to the criticism of use of theories in practice where for many years, nurses have had to do what has been taught and they are uncertain of the outcome of their own practices. As a result, many critics view the use of theories as taking a nurse away from what is important, that is, ‘the patient’. Alligood goes further to point out that the use of behavioral and habit-based thinking in practice lead to a form of alienation where things are done out of what people know in their own ways. This has greatly led to a belief that the application of theories in nursing practice is just but ‘another form of evasion’. He concludes by noting that there should be a more sensible approach as to why a person can embrace the use of theory in his or her practice and it is in this line that the challenges and criticisms can be addressed. All these scholars, according to Fitzpatrick and Whall (170), underscore the significance of employing the available theories in deciding approaches and intervention in patient care. However, Zimmermann (90) cautions that these are only possible if the academic and practicing nurses collaboratively pull in the same direction. She notes that history is littered with the tendency of what the scholars’ notes and opinions differ significantly with what the practicing nurses want to do and it is important that nurses should know that theory embrace is not an imposition of their work but it is a collaborative effort that will help to develop the profession and improve the patient care.
3. Use of Conceptual Models in Nursing Practice
The use and development of nursing theory in general and conceptual model in particular will continue to be crucial to the ongoing development of the profession and the practice of nursing. As Horsley (1993) notes, the “ultimate aim of any profession is to improve the quality of life for all members of society”, a goal for which theory-based practice is fundamental. However, the increased use of conceptual models and the development of an “intermediate range theory” based on these models (Ruland & Moore, 1999) depend on the profession’s continued commitment to promoting “critical reflection and creative thinking” amongst practicing nurses (McKenna, 2007). By supporting nursing research that incorporates and develops such models, academic institutions and professional organizations can help to provide nurses with the tools they need to understand and apply these theories in daily practice.
By providing a nursing-specific focus, these alternative models have begun to inform new directions in nursing research and practice. This may help to explain the recent proliferation of such models within the profession. For example, Pender’s “Health Promotion Model” is based on the concept of promoting the patient’s health through a focus on a particular “positive” aspect of the patient’s overall health state, known as the “health promoting behavior”. By using the model to describe the complex relationship between the patient’s motivation for health promotion and the nurse’s role in helping to facilitate such behavior, it is hoped that the practicing nurse may gain some insight into the most effective ways of helping the patient to achieve his or her health-related goals. This is but one example of the ways in which a conceptual model may be used to guide the development of practical nursing knowledge.
As McCurry, Revell, and Roy point out, nurses have historically focused on two key concepts: “nursing” and “health”. Based on different ways of understanding these two concepts and the relationships between them, different theoretical models of nursing have emerged – “each with its own conceptual definition of nursing and its own unique perspective of what conditions promote optimal patient health”. Theories and models in nursing originated in other disciplines, such as biology and psychology, as well as leadership and economics. While early nursing theories were often “grounded in a framework of medical biology”, more recently nursing has embraced other ways of thinking, such as “family systems and stress theory” (McKenna, 2007).
A conceptual model is a representation of some phenomenon that helps us identify its most important characteristics and suggests which aspects we might wish to study further. In the context of nursing and patient care, conceptual models are particularly useful in that they emphasize the relationships within and between phenomena – in this case, the various factors that contribute to a patient’s health and the ways in which nurses might approach addressing these factors. In other words, conceptual models are like “health maps” that aid both in understanding the complex nature of health and in planning appropriate interventions.
3.1. Overview of conceptual models in nursing
The concept of nursing models and the nurse’s role in the healthcare setting has changed and evolved greatly over time. This section of the essay will provide an overview of several conceptual models and their use in driving professional behaviors and actions. Conceptual models can increase the knowledge base of those in the profession, but there is still a large gap between research findings and practical application. Nurses continue to use and develop conceptual models, but the variety and quality of models in use has not yet reached a level where the unifying theory of nursing is in sight. Conceptual models also direct the development of the knowledge of the discipline and may lead to changes in nursing practice. Some conceptual models are holistic and connect to the environment and its impact on well-being; others reflect the nurse’s place in the healthcare setting and describe universals regarding patient and nursing goals. Examples of individual conceptual models, selected from practice and education settings, will be used to illustrate the points made in this section. Seven categories of conceptual models in the professional literature have been identified, namely:
– Theories specific to the science of nursing
– Models specific to the science of nursing
– Models in the nursing service (administrative) literature
– Theories in nursing education
– Nursing models that specify the relationship between and among the concepts
– Concepts in nursing
– Models and theories from related disciplines, such as sociology, psychology, and management.
3.2. Advantages of utilizing conceptual models
A conceptual model offers a comprehensive approach to the conceptualization of complex nursing activities, helping to show the interactive relationships between the activities, the interventions carried out, the outcomes achieved, and the evidence that supports the practice. It can aid in the organization of care in order to maximize the efficiency and effectiveness of the nursing process, taking into account factors such as workflow, human factors, and the use of resources. Each conceptual model has its own strengths and weaknesses, but all are united in the provision of a broad, generalized structure in which to work, thus providing guidance and direction to the practice of the profession. Keeling (2007) added that “when nurses use nursing conceptual models, they use an established set of terminology and diverse scientific research dedicated to the advancement of professional knowledge.” According to Risjord (2010), one of the key advantages of utilizing conceptual models is the formation of a scientific foundation for the provision of evidence-based nursing practice. This is due to the fact that by using the concepts and propositions set out in the specific scientific model, the system of the theory will be the driving force of the investigation, thus encouraging the critical appraisal of the scientific knowledge used within the model. Also, the tested truth behind the scientific knowledge (in the form of evidence) will be proof for the provision of evidence-based nursing practice. This will support the credibility of nursing in that it will show that the nursing interventions used have a scientific rationale. Castro and Scanlon (2010) noted that such practice of using nursing conceptual models may indeed set the path in answering unresolved challenging clinical problems, as it encourages critical thinking in the analysis and solution to the problems encountered. The benefits of using models were also highlighted by Schaefer and Parker (2007) where they suggest that such an approach constrains the work of the research to questions that are of particular interest to the discipline and moreover, patient care researches following the stipulated guidelines by the conceptual model will be encouraged and findings based on the evidence provided will aid in the development of nursing care quality. Murdach (2012) adds that “nursing research and practice should not continue to rely on nursing traditions of the past without questioning the way things have been or are being done.” This was echoed by Risjord (2010) that the use of nursing conceptual models was an essential step to establishing a professional discipline with a distinct domain of nursing science.
3.3. Examples of widely used conceptual models
A widely used conceptual model in nursing is Neuman’s Systems Model, which was developed by nursing theorist Betty Neuman. The model is based on the idea that a patient’s response to an illness is affected by a variety of factors, meaning that treatment must address those factors as well as the illness itself. The Neuman Systems Model is widely used in nursing practice because it can be applied to a variety of different practice settings, such as psychiatric nursing, critical care, and inpatient nursing. It is also used to provide a holistic overview of a patient’s health, which can be central to making care decisions in a modern healthcare environment. Another key advantage of the Neuman Systems Model is that it emphasizes health promotion as well as illness treatment, meaning that nurses can use the model to develop effective strategies for keeping patients healthy both physically and mentally. The model encourages nurses to develop a deep understanding of patients’ physiological and psychological health through careful, ongoing patient assessment. By using patients as active participants in their own health management, rather than simple recipients of care, Neuman’s Systems Model can help in giving nursing practice a patient-focused, empowering outlook. Well recognized nursing scholar Martha Raile Alligood contributed significantly to the development of the model by helping to refine and formalize it. Neuman’s Systems Model has been used to inform the creation of various other nursing theories, showing its wide ranging influence on nursing as an academic and practical discipline. For example, the model may be used in the development of nursing knowledge for nurse education, and is also used in directing and structuring professional clinical and administrative practice, including practice guideline formation. Neuman describes the use of her model as providing a preventive, prescriptive and holistic focus to nursing and that these different elements of the model’s application to practice help to comprehensively address patient’s health. And the widely use of Neuman Systems Model was well shown in different practice settings and also now it has influenced the process of patient assessment and care plan development for nursing.
4. Conclusion
Throughout the paper, I have identified how historical events and influential nursing leaders have impacted the healthcare delivery systems in the world. During the course of my research, I came to the conclusion that by learning from the achievements and mistakes in the past, this will help nurse leaders in the policy development process in the future. The policies developed should then have attributes of beginning to work towards the objectives of the Institute of Medicine (IOM) – that is improving the quality, safety, and the access to care for patients, families and even the community which are more focused on the outcomes. I also discovered that nursing theories are important in today’s nursing practice as it serves as a foundation. This is important to guide and to educate the nurses and to realize what are the things that they will need to focus on. I think this is the kind of reality that we are looking at – if a piece of knowledge cannot withstand the ability to predict, then it is not a reality. It is just a theory. However, not everybody can see the physical truth. By modernizing the theories in terms of quantitative use or by qualitative study, then maybe nurses can start realizing the philosophy of reaching the professional autonomy. Also with the impact from historical evolution of the nursing and the healthcare systems, the ongoing contribution from the nursing and other professions leaders will help to set the correct strategic direction and reforms. The transformations of how the healthcare system reforms and how the potential for transformation affects the nursing profession, it can be build upon the practices from such influential persons and their attitudes into leadership, come up with the effective changes that can be crucial in the process of the policy developments and implementations. And in conclusion, medical profession has grown and so it is nursing profession. But it is important to really appreciate what have the professions gone through. The past, the present and the future were discussed in the course of the paper and each conclusion has been supplied with an evaluation based on the proper recognitions from the historical importance to our professional development and practices. And lastly, we must continue discussing in the public policy, research, education and clinical practices that will help this profession to get more autonomous, more proactive and have more lateral work progress. Because the vision of nursing as a professional autonomy by 2021, can be better achieved. And that’s what our professionals have been looking forward.
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Influence of Historical Events and Nursing Leaders on Nursing Practice.
Describe how historical events and nursing leaders have influenced the practice of nursing Evaluate the use of nursing theory theory in nursing Evaluate the use of conceptual models in nursing practice Describe how historical events and nursing leaders have influenced the practice of nursing Evaluate the use of nursing theory theory in nursing Evaluate the use of conceptual models in nursing practice
