effort, the means which the hospital can provide are needed to carry out its immediate purpose, which is the care of the sick, and any scheme of education must, of necessity, take a secondary and insignificant place” (Nutting cited in Grace, 1978, p. 20). In other words, nursing education had to get out from under hospital control. But, until the mid‐1950s, most nursing programs continued in the 3‐year diploma, hospital‐based training model.
University programs for nurses had been around since 1909, but their development was accelerated by a study, commissioned in 1948 by the National Nursing Council, to examine who should organize, administer, and finance schools of nursing. The National Nursing Council was composed of multiple constituent nursing organizations. The study's Director, Esther Lucille Brown, an anthropologist, strongly recommended that nursing education move out of hospitals and into colleges and universities (Brown, 1948). Starting in the mid‐1950s, the number of 3‐year diploma, hospital‐based nurse training schools went down and the number of baccalaureate and associate degree programs increased.
In the early 1950s, after World War II, there occurred, as has happened quite regularly over the years, a nursing shortage. Nurses leaving the profession, many of whom wanted to get married or to start a family after the war, exacerbated this shortage. Other nurses, who had served in the armed forces, didn't want to return to the constraints and rules of civilian nursing and, possibly, wanted to utilize the G.I. Bill of Rights to gain a college education. In addition, the Hill‐Burton Act of 1946 supported extensive new hospital construction, which required more nurses. Mildred Montag, a nurse who was pursuing a doctorate in education at Teachers College, Columbia University, in New York, proposed a novel educational solution. Her dissertation, titled “Education for Nursing Technicians,” proposed a 2‐year Community College program for nurses. Nursing technicians could, as conceived by Montag, perform the technical rather than the professional components of nursing (Montag, 1963). A later grant enabled Montag to put her proposal into action in seven Community Colleges in six states, New York, New Jersey, Michigan, Utah, California, and Virginia (Montag, 1959). Montag's study showed that the 2‐year nursing program, and at this time it was just 2 years, with 1 year of general studies and 1 year of nursing, attracted non‐traditional students. Furthermore, graduates of the 2‐year program compared favorably with 3‐year diploma graduates in terms of test scores and satisfaction from all parties. Montag's plan was for the 2‐year associate degree program to develop a technical nurse—not a “professional” one (Montag, 1963). She thought that associate degree and baccalaureate degree programs should not blend with each other because they were just too different (Orsolini‐Hain & Waters, 2009). Supported by the Nurse Training Act of 1964, associate degree nursing programs grew exponentially. By 1980, approximately 80% of new graduates were from associate degree programs (Orsolini‐Hain & Waters, 2009).
Meanwhile, back in 1899, Teacher's College at Columbia University in New York had established the first graduate education program for nurses in the fields of hospital economics and educational administration (Grace, 1978). However, the bulk of nursing graduate education was developed in the 1950s and 1960s, as the need for nurse educators in the college programs expanded (Gerard, Kazer, Babington, & Quell, 2014). The early nursing graduate programs focused mainly on education and administration. Later, in the 1960s, graduate degrees for clinical nursing roles came to the forefront (Gerard et al., 2014).
The Development of Nursing Research in the 1950s to the 1970s
Early nursing research focused on the education of nurses. This was understandable because graduate degrees for nurses had been based on theories of education. But as nursing education started to shift away from hospital‐based schools to colleges and universities, a separate and independent body of nursing knowledge was needed. That is, nursing needed to clarify the scientific knowledge behind nursing practice.
Essential to an independent body of nursing knowledge was the development of independent theories of nursing. In 1959, nurse Dorothy Johnson wrote: “…the question of the existence of a body of substantive knowledge which can be called the science of nursing…is a question of considerable significance for nursing's continued development as a recognized professional discipline” (Johnson, 1959, cited in Tobbell, 2018, p. 65). Historian Dominique Tobbell (2018) has outlined three reasons why theories of nursing were developed during the 1960s and the following decades.
First, most doctorates that nurses had obtained were in education or, to a smaller degree, in the social and behavioral sciences. These disciplines all had their own theoretical orientations.
Second, nursing wanted to show that it was separate from medicine. Thus, nurses did not want to use the biomedical sciences as their theoretical base since they were in use as the base for medical science,
Third, distinctive nursing theories differentiated nursing science from other disciplines.
In 1972, the NLN required that a nursing conceptual model should frame nursing curricula. Within the 1950s, 1960s, and 1970s, many nurse theorists developed theories of nursing science based on a functional view of nursing and health (Im & Chang, 2012). Table 3.2 details several prominent nurse theorists and their work.
Table 3.2 Prominent Nurse Theorists and Their Work
Source: Compiled with information from Nursing Theory at www.nursing-theory.org. Retrieved on October 3, 2019.
| Nurse theorist | Theory | Brief description |
|---|---|---|
| Helen Erickson | Modeling and Role Modeling | Recognizes the unique perspective of each patient; accepts that the patients are experts in their own care. |
| Virginia Henderson | Need Theory | Supports patients to become as independent as possible. |
| Imogene King | Theory of Goal Attainment | Describes a dynamic, interpersonal relationship in which a patient grows and develops to attain certain life goals. |
| Madeleine Leininger | Culture Care Theory | States that Nursing is informed by patient's culture and cultural background. |
| Betty Neuman | Neuman Systems Model | Has a holistic view of patients; patients are seen as people and not merely a pathology. |
| Dorothea E. Orem | Self‐Care Deficit Theory | Helps patients become more independent by recognizing that people want to care for themselves. |
| Hildegard Peplau | Theory of Interpersonal Relations | Describes 7 roles of nursing, which are applied selectively to optimize care. |
| Callista Roy | Adaptation Model of Nursing | Promotes adaptation of patient to health and to illness. |
| Jean Watson | Philosophy and Science of Caring. | Uses caring as a generalized framework for nursing. |
Emerging Nursing Specialization in the 1980s and 1990s
With the introduction of Diagnosis Related Groups in 1983 as an attempt by the U.S Federal Government to rein in Medicare costs, the number of hospitalized