During the years between 1977 and 1979 I was pursuing a Master of Science degree with a focus on psychiatric mental health nursing at Virginia Commonwealth University. It was a time of professional excitement and personal struggle. I was a single father of an adopted three-year old daughter. I had delayed pursuing my graduate degree to allow time for the adoption process to unfold and to give us time to adjust to our situation as she was only 18 months old when she came to live with me.
One of the graduate courses I took was focused on nursing theories. In fact, it really was a mixture of a variety of theories such as communication theory, group theory, and family theory. The “nursing theory” portion of the course was dedicated to the grand conceptual models prevalent at the time. The faculty was enlightened enough to know the significance of these conceptual models for advancing the development of the science and practice of nursing, but the approach was to have groups of students work together and do a presentation of each dominant conceptual model for the entire class.
It was clear that although the professors were acknowledging their importance, most of them knew very little about the sophistication of the ideology, assumptions, ontology, and epistemology underlying the models. There was no emphasis on comparisons among them and this predated the work of some leading nursing scholars to identify the essence of nursing science and many books published on grand and middle-range theories in nursing. However, in all fairness to the professors and curriculum team who identified content for this course, students were offered some familiarity with and recognition of the importance of the primary conceptual models of nursing. Perhaps the faculty and academic leaders had an understanding, if not a deep appreciation of the role of the discipline in establishing its unique or at least distinctive boundaries of knowledge.
At the time I was fascinated with existential theory, thanks to the leadership of the chair of the psychiatric-mental health department who had studied at Boston University and the only faculty member who had a doctorate in nursing. She studied existential theory generally and the work of Paterson and Zderad who offered a metaparadigm of humanistic nursing (O’Connor, Paterson, & Zderad, 1993). My interests focused on the concept of freedom and its meaning and application to nursing. I believed that this concept was of major significance to the care of people and later led me into appreciating the ideals of liberation of humans in the nurse-patient relationship both in developing praxis and inquiries.
In the theory course, I was assigned to Rogers Science of Unitary Human Beings (Rogers, 1992) with a group of classmates. While I was somewhat enthralled by what I discovered and felt it was at least more interesting than any of the others, I really struggled with its practical relevance. My own personal life and spiritual understandings of the universe resonated with many of the concepts, but I thought I was too naïve to think about applying any of this to research and practice, and somewhat doubted it could be translated into research and practice.
Two very disparate things happened. I veered completely away from nursing theory and did a master’s thesis on locus of control and learning in nursing students. And for some reason I knew for sure that nursing needed a greater accent on theory development and a stronger emphasis on the knowledge that distinguished the discipline. I also was determined by 1978 to get a PhD in Nursing, much against the advice of my thesis chair who asked me why in the world I would uproot my life and my daughter to go to one of the few places (18 programs offered a PhD at the time) to pursue this goal when there were plenty of PhD programs in Virginia in other disciplines.
I requested information from all the nursing doctoral degree-granting institutions and without reservation chose to apply to only one – New York University (NYU) because the degree was a PhD in Theory Development in Nursing Science. Reading the materials about the philosophy, values, ideals, and the curriculum plan convinced me that it was best suited for my ambition to contribute to theory development in nursing. I went to NYU planning to expand on my thesis research related to locus of control in nursing education with an emphasis on promoting freedom of choice in learners. I had no inclination to ground my dissertation in any of the grand nursing conceptual models and frameworks. A course that was required as a prerequisite for all PhD students was called “Science of Man” taught by Martha Rogers. I had heard Martha speak at a national theory conference in New York City in 1978 and liked the way she pushed the boundaries of nursing science and beyond. Once again, I was more concerned about practicality rather than the need to develop a unique basic science of nursing.
Spending time with Martha and the other students engaged in some hefty dialogue about what constituted the science of nursing was transformative for me. I think that spending the time and effort to dive deeply into the conceptual underpinnings and emerging theoretical propositions of a single framework allowed for the kind of study that is necessary to truly understand and appreciate a conceptual/theoretical perspective. This kind of deep and engaging teaching/learning experience is not seen as a relevant approach to exploring the foundations of nursing as a discipline or considering avenues of theoretical development for nursing. Unlike most disciplines, students at the undergraduate and graduate levels of nursing education do not receive foundational knowledge that guides and animates a discipline. In most other disciplines PhD students seek out a place where they know they can receive education and mentoring that reflects a theoretical perspective that attracts them and might be useful toward their professional pursuits. Rarely are PhD programs in nursing known for a focus on a set of theories that are most significant to the discipline and underlie faculty work and expertise.
I had many formative years in the discipline that were rooted in discovering nursing and what it was all about as a high school volunteer and nursing assistant followed by formal education at diploma, bachelor’s, master’s, and a theory development focused PhD program. The curriculum design of the NYU PhD Program in Nursing at that time was built around the ideal of immersing students in theory development courses and seminars that related to the phenomenon of interest of that student. Courses and seminars were constructed in a way that provided every student an opportunity to present to faculty and classmates their progressive theoretical thinking that would guide questions asked, propositions/hypotheses made, and research design selected. Of course, individual mentoring was an important part of this process as well.
The point is that every student was given the opportunity to appreciate the meaning and power of theoretical thinking and theoretical development using their own dissertation research as a focal point, engaging in dialogue and critique of the work of others (including that of PhD graduates from the program), and to consider how one’s work related to the larger theoretical needs of the discipline based on debates about the phenomena of most significant concern to nursing.
The point of this blog is not to reminisce about my own education and its meaning to my work, but to share what I think are the reasons that devoting one’s professional life to theory development in nursing is a worthy endeavor. It is difficult to maintain the standing necessary to progress in nursing academics if one focuses mainly on theory development rather than in successfully generating research funding and reporting on research findings in one’s scholarly contributions. Over my career, there were moments when, particularly early on that I digressed from focusing on theory development and this was useful to my career but not to my discipline or to my growth as a scholar in any substantial way. I believe that there are compelling reasons for more of us in nursing academics, and beyond, to devote ourselves to the discovery, generation, and elaboration of theories grounded in the discipline of nursing. This in no way implies that there are not a vast number of academic colleagues throughout the US doing meaningful and important work that has improved the outcomes of the care of patients, families, and communities. I am also not implying that discipline-specific nursing theory development cannot be done as a complement to research engagement that extends and revises theories.
What I am suggesting is that giving attention to theory development in a variety of forms is a way of enhancing and improving nursing research and practice and ultimately improving the well-being of our society. I am calling for an antidote for a singularly focused dominant pursuit of research that often fails to address the distinctive needs of the discipline and those we serve. Every discipline has its distinctive, if not unique, disciplinary focus that defines the core knowledge. Degrees are given in a field and those degrees signify that the graduate has a foundation in that knowledge. Career pursuits are supported by sources that understand and seek the need for individuals with this specific kind of disciplinary knowledge. This is not elitist. It is a responsible obligation to the society we live in to be clear about the boundaries of the discipline one professes to embrace.
The compelling reasons to call for a greater emphasis on discipline-specific theory development include:
- There has, and always will be, phenomena in the health/illness experience of people that require the particular attention of nurses due to their societal mandate and reasons for existence.
- Nurses are placed in a unique, close, and involved relational proximity with people who are served by nursing in a variety of roles and contexts, thus giving them access to a deeper and richer appreciation of the phenomena of concern to people’s health and well-being. This relational proximity is one that allows for the appreciation of the perspective and wishes of people that needs consideration in the development and use of underlying theories that guide nursing interventions and informs broader clinical practices.
- To acknowledge the theoretical thinking of nurses as a relevant and meaningful contribution to advancing the well-being of human beings is to recognize the significance of the nursing point of view amongst the various disciplines related to healthcare improvements.
- Emerging phenomena in health such as pandemics, vaccine reluctance, increases in drug addiction and its consequences, advances in surgical interventions, and the deepening healthcare disparities, to name only a few, require the attention of new and innovative theoretical thinking to address and improve health outcomes and human well-being.
This blog calls for greater conversations and considerations of the role of discipline-specific theory development efforts. Nurses are being educated for the most part to ignore this significant aspect of inquiry, discovery, and creativity that could enhance the lives of many people, families, and communities. There are multiple examples of the headwinds faced in moving in or returning to this direction which at one time was the cornerstone of PhD nursing education. These exist in criteria and standards for publication, academic advancement, and funding opportunities for inquiries. This blog alone cannot fully address the history, meaning, and pertinence of encouraging more focus on theory development in nursing. Perhaps it can provoke meaningful dialogue, suggestions, and opportunities for change.
I knew from the first time I walked into a hospital to do volunteer work as a sophomore high school student that nurses made such a significant difference to the patients’ wellbeing and recovery that might even make a difference in their survival. I did not have a name for what they did and certainly couldn’t understand how their presence played such a vital role in what might occur next for a patient. I finally understood that what they did was nursing and wanting to know more about why their work was so significant eventually led me to a career mostly devoted to theory development in an area of conceptualization that I thought would push the boundaries of what is possible. The journey that opened for me was perfect and I am indebted to those who had the courage to believe that theoretical development was more than worth the investment and share their wisdom with me – mentors, colleagues, students, and even people who participated in my avenues of inquiry and practice.
O’Connor, N., Paterson, J. G., & Paterson, J. G. (1993). Paterson and Zderad : Humanistic nursing theory (Ser. Notes on nursing theories, v. 7). Sage Publications.
Rogers, M.E. (1992). Nursing science and the space age. Nursing Science Quarterly, 5(1), 27-34.