Posted: September 8th, 2023

The Evolution of Nursing Knowledge

The development of nursing knowledge is an ongoing process. Discuss the case for the ongoing development and use of nursing grand theories and conversely, make a case for the obsolescence of nursing grand theories for today’s practice and research.
________________
The Evolution of Nursing Knowledge: The Role of Grand Theories in Modern Practice and Research
Introduction
Nursing knowledge and practice have evolved significantly since the inception of the nursing profession in the late 19th century. Over time, nurses have developed various frameworks and models to better understand the multidimensional nature of health, illness, and the nursing role. Grand theories, which attempt to explain nursing phenomena on a very broad level, played an important role in establishing nursing as a discipline and advancing the scientific basis of the profession. However, as the healthcare landscape and nursing practice have changed dramatically in recent decades, some argue that grand theories are no longer relevant to guide modern nursing. This article will explore both sides of this debate by examining the historical role and ongoing value of grand theories, as well as arguments for their obsolescence in light of contemporary nursing priorities and approaches.
Historical Role and Ongoing Value of Grand Theories
The development of grand theories in the mid-20th century was a pivotal moment for nursing (Fawcett & Desanto-Madeya, 2013). Theories proposed by nurses like Florence Nightingale, Hildegard Peplau, Dorothy Johnson, and Myra Levine helped establish nursing as a unique discipline with its own philosophical underpinnings and focus on holism, humanism, and the nurse-patient relationship (George, 2011). These theories provided frameworks to understand concepts central to nursing like the patient environment, interpersonal relations, and basic human needs. They also guided the development of standardized nursing diagnoses, taxonomies, and language (Fawcett & Desanto-Madeya, 2013).
Proponents argue that grand theories still offer value today by providing overarching perspectives on the multidimensional nature of individuals and their health (George, 2011). For example, Orem’s Self-Care Deficit Nursing Theory emphasizes that nursing should support patients’ ability to care for themselves (Petiprin, 2016). This focus on empowerment and self-management remains highly relevant. Levine’s Conservation Model also stresses the importance of considering all aspects of a patient’s being—including physiological, psychological, sociocultural, developmental, and spiritual dimensions (Nursing Theory, 2016). Such holism continues to be a core principle of modern nursing practice. Grand theories also help establish nursing’s social mandate and identity as a caring profession (George, 2011).
Grand theories can still guide research by providing testable frameworks and hypotheses (George, 2011). For example, King’s Goal Attainment Theory has been used to study nurse-patient interactions and develop interventions to improve health outcomes (Nursing Theory, 2016). Research informed by grand theories also helps expand nursing knowledge in a conceptually coherent way (George, 2011). Overall, proponents argue that while healthcare has advanced greatly, the fundamental tenets of major grand theories remain applicable to practice and the continued evolution of the discipline.
Arguments for Obsolescence of Grand Theories
However, some compelling counterarguments have been made that grand theories are no longer optimally suited for contemporary nursing. A key criticism is that grand theories proposed decades ago were developed in very different healthcare contexts and may not fully account for modern complexities (McEwen & Wills, 2019). For example, theories created in the mid-20th century did not anticipate advances like genomics, technology, and emphasis on chronic disease management that now dominate healthcare. Grand theories also tend to be very broad and not easily testable, making them less useful for guiding empirical research in an evidence-based era (George, 2011).
There is also a lack of consensus around any single grand theory, limiting their ability to unite and direct the entire nursing profession (George, 2011). Instead, nursing has embraced a plurality of mid-range theories focused on specific populations or problems rather than global conceptualizations of nursing (McEwen & Wills, 2019). For instance, theories of grief, coping with chronic illness, and family systems are more applicable to guiding modern practice areas. Grand theories are also criticized for being too abstract and philosophical rather than pragmatic or prescriptive enough to provide clear clinical guidance (George, 2011).
Finally, nursing’s priorities have evolved from establishing its identity to delivering high-quality, patient-centered, and fiscally responsible care (McEwen & Wills, 2019). Grand theories were created in an era when nursing sought recognition as a discipline separate from medicine; today, interprofessional collaboration is emphasized over distinct professional silos and boundaries (George, 2011). In this context, some argue that grand theories are more concerned with nursing’s internal development than external priorities like improving population health outcomes.
Discussion
There are reasonable perspectives on both sides of this debate. While grand theories played an invaluable role in nursing’s past, aspects of their limited scope, lack of consensus, and philosophical abstraction do constrain their utility for modern practice and research demands. At the same time, the fundamental principles of holism, humanism, and caring established by grand theories remain highly relevant and can still guide the profession’s core identity and social mission.
A balanced view is that grand theories continue to offer valuable historical and philosophical context for nursing but should not be seen as prescriptive or the sole frameworks for the discipline. Their broad perspectives need to be complemented by more pragmatic mid-range and practice theories tailored to contemporary priorities. Nursing knowledge will also continue evolving through integration of diverse theoretical and empirical approaches rather than allegiance to any single paradigm. Overall, an appreciation of enduring ideas from nursing’s past, coupled with flexibility and innovation, will best support the ongoing development of the profession.
Conclusion
In summary, grand theories have played an indispensable role in establishing nursing’s philosophical foundations and advancing the discipline since the mid-20th century. However, arguments have also been made that their limited scope and increasing abstraction constrain their ability to guide modern nursing practice and research demands. A balanced perspective recognizes grand theories’ ongoing value in articulating nursing’s core principles and social mandate while acknowledging the need for diverse, pragmatic frameworks tailored to today’s complex and evidence-based healthcare environment. An integrated and flexible approach combining enduring insights from grand theories with new mid-range and practice models will best support nursing knowledge’s continuous evolution.
References
Fawcett, J., & Desanto-Madeya, S. (2013). Contemporary nursing knowledge: Analysis and Assessment of nursing models and theories (3rd

Order | Check Discount