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NSQXXX10.1177/0894318418755734Nursing Science QuarterlyFawcett / Essays on Nursing Science

Essays on Nursing Science

Nursing Science Quarterly

Thoughts About Nursing Curricula:


2018, Vol. 31(2) 185­–189
© The Author(s) 2018
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DOI: 10.1177/0894318418755734
https://doi.org/10.1177/0894318418755734
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Marian C. Turkel, RN; PhD; FAAN,1


Jacqueline Fawcett, RN; PhD; FAAN,2 
Linda Amankwaa, RN; PhD; FAAN,3
Pamela N. Clarke, RN; PhD; FAAN,4
Vivien Dee, RN; PhD; FAAN,5
Rosemary Eustace, RN; PhD,6
Phyllis Shanley Hansell, RN; EdD; FAAN,7
Dorothy A. Jones, RN; EdD: FAAN,8
Marlaine C. Smith, RN; PhD; FAAN,9
and Rothlyn Zahourek, RN; PhD; FAAN10

Abstract
In this essay, several nurse scholars who are particularly concerned about the contemporary state of nursing science present
their concerns about the inclusion of nursing conceptual models and theories in the curricula of nursing programs (dark
clouds) and ways in which the concerns have been addressed (bright lights). This essay is the second of two essays that were
catalyzed by Barrett’s paper, “Again, What Is Nursing Science?” The first essay was published in the previous issue of Nursing
Science Quarterly.

Keywords
nursing curriculum, nursing conceptual models, nursing science, nursing theories

Marian Turkel and Jacqueline Fawcett: This essay is the some nursing programs. Yet we expect some semblance of
second that was written in response to Barrett’s (2017) connectedness around the topic of science of nursing or nurs-
“Again, What Is Nursing Science?” The authors were pro- ing science among nurses.
voked to respond with their thoughts about our discipline, I maintain that all nurses should know or at least be
which was published in the previous issue of Nursing Science exposed to their science and the term nursing science. If this
Quarterly (Turkel et al., 2018). The essay in this issue of is what we do, then why shouldn’t we, all of us, be doing
Nursing Science Quarterly is a compendium of the authors’
1
thoughts about the contemporary focus of nursing curricula. Associate Professor, Christine E. Lynn College of Nursing, Florida
Atlantic University, Boca Raton, FL, USA
As in the previous essay, the responses were categorized as 2
Professor, Department of Nursing, University of Massachusetts, Boston,
dark clouds and bright lights. MA, USA
3
Associate Professor, Nursing, Albany State University, Albany, GA, USA
4
Professor/Executive Nurse Leader Fellow, University of Wyoming Fay
Dark Clouds W. Whitney School of Nursing, Laramie, WY, USA
5
Professor, Doctoral Nursing Programs, School of Nursing, Azusa Pacific
Linda Amankwaa: The debate about questions such as
University, Azusa, CA, USA
“What is nursing science?” “Who cares?” and “Who knows?” 6
Associate Professor, College of Nursing and Health, Wright State
(Barrett, 2017) is one that only the nursing elite get to dis- University, Dayton, OH, USA
cuss. Think for a moment. Who can even participate in the 7
Professor, Seton Hall University, South Orange, NJ, USA
8
debate? Why fully a majority of those whose license contains Professor of Nursing, Boston College, Director Emerita and Senior
Nurse Scientist, Yvonne L. Munn Center for Nursing Research, William F.
the word nurse cannot participate is because the phrase nurs-
Connell School of Nursing, Chestnut Hill, MA, USA
ing science may be mentioned, but its importance is not 9
Dean and Helen K. Persson Eminent Scholar, Christine E. Lynn College
emphasized in the curricula of all nursing programs. I would of Nursing, Florida Atlantic University, Boca Raton, FL, USA
venture to say that nursing science is not even mentioned in 10
Belchertown, MA, USA
186 Nursing Science Quarterly 31(2)

“nursing science”? Other questions to ask are: If we are knowledge, nursing theory, and nursing science be advanced
nurses and we have a nursing science, when do we expose a when it is not part of the curriculum? If doctoral dissertations
nurse to the science? Who decided this? If Nightingale wrote are not informed by nursing theory, how will research related
the beginnings of our science, is this not the science of all to nursing science be advanced?
nurses including but not limited to those with the word nurs- Pamela N. Clarke: Indeed, where is nursing science in
ing in their license? We must question why our discussion of doctoral programs? Some schools introduce nursing science
nursing science begins at the end of the road (such as in nurs- at the doctoral level. Language tends to be confusing, refer-
ing doctoral programs) and not at the beginning (at the start ring to clinical leadership to improve and transform health-
of prelicensure programs). It is hard to convince everyone if care. Would that not be true for pharmacists and other
we have not educated them. providers? Are these doctoral students not also responsible
Pamela N. Clarke: I have sampled top ranked nursing for improving and transforming nursing science? Leadership
schools and examined their curricula. Very few programs is the trendy concept, but how can nurses possibly lead with-
were solidly based on nursing theory and science with a clear out nursing knowledge?
picture of nursing knowledge. A large number of programs Rothlyn Zahourek: I share Barrett’s (2017) concern
refer to theories and evidence-based outcomes, but it is not about the split of emphasis and two distinct paths occurring
clear whether the evidence is from nursing science or other in nursing doctoral programs. One path emphasizes nursing
disciplines. Some have courses on theories related to nurs- as an applied science based on the theories from other disci-
ing, but there is little about nursing theories that can be deter- plines, and therefore, interdisciplinary and team research is
mined from looking at websites. There is more attention to emphasized. The other path emphasizes nursing theory-
interprofessional practice than to nursing theory-driven prac- based research that supports the view that nursing is a sci-
tice. Few programs consistently emphasize nursing concep- ence and a discipline unto itself.
tual models and theories from the beginning of the curriculum Jacqueline Fawcett: Which is the better path? For what
to help students build their nursing knowledge within the purpose is that the better path?
context of the discipline. How much better it would be to Dorothy A. Jones: Barrett’s (2017) article is both timely
have nurses who go beyond physician orders so that gradu- and brings attention to an issue that threatens the future of
ates can approach people as nurse theorists with a vision and nursing knowledge development. As she so clearly reinforces,
clear understanding of nursing knowledge. Are advanced our disciplinary perspective, our science, is being lost to the
practice nurses practicing advanced nursing or mini-medi- infusion of an interdisciplinary focus that continues to obscure
cine? Is it ethical to portray to the public that the provider the unique contributions of nursing science to the global com-
will use advanced practice nursing knowledge when the munity that nurses serve. The threat of this shift is most obvi-
main focus is diagnosis and treatment? Or do we take the ous in an increasing number of our doctoral programs where
position that consumers will not know the difference so it is the development and refinement of nursing knowledge is
not necessary to explain what nursing is, separate from medi- being replaced by theoretical guides from other disciplines
cine? How does the nurse participant on a team in any setting with a goal that differs from that of nursing. This trend affects
portray that which is unique—that is, the holistic knowledge undergraduate and master’s degree education, where the dis-
approach that underlies nursing practice? semination of nursing conceptual models and theories and
Rothlyn Zahourek: Barrett (2017) has underscored the essential substantive content is being replaced or at best
trend of not teaching the nursing conceptual models and the- blurred in its importance … nice to know but not necessary.
ories that have been successfully used for several decades. Rosemary Eustace: As a nurse scholar and educator, I
What a shame. Of great concern to me is that no longer are find it very disturbing when I hear students voice their frustra-
we teaching these nursing conceptual models and theories in tions about nursing theory as they ask: “Are we really going
undergraduate or graduate programs; now it appears that to use this in nursing practice? When I was in the hospital, I
nursing science is regarded as having little or no relevance did not see nurses using any theory to take care of my loved
for scholarly work. Yet without knowledge and appreciation one; they just did what they were supposed to do!” Similarly,
of nursing science, which also forms and illuminates our his- I have heard some faculty express these opinions about nurs-
tory, all levels of students will miss learning the basis of our ing theory: “We do not need a theory class!” “Undergraduates
profession. Without nursing theory-guided research and the are not going to do research, so they do not need a theory
subsequent science, we become a trade whose members care class.” “Nursing theories are old, no one cares about them
for others, promote health, and who are not professional but nowadays, we used them during the old days to guide our cur-
instead are ancillary and placed into the despised category of riculum!” “I will teach my own theories in my clinical
“midrange practitioners.” courses; my graduate students do not need a class on nursing
Marian C. Turkel: It is alarming to look at nursing cur- theory!” “We don’t have a PhD program, so we do not need a
ricula from some major universities and see that nursing separate nursing theory class!” I contend that as the largest
theory courses are not part of the curriculum at any level of healthcare profession, we have to overcome historical, regu-
education. How will the future of nursing discipline-specific latory, and policy barriers by theorizing nursing. We need to
Fawcett / Essays on Nursing Science 187

do better to determine our own value-added contribution to theories were developed to help focus the discipline on nurs-
patient health outcomes (Gebbie, Wakefield, & Kerfoot, ing science, rather than merely using the science of other dis-
2000). We have to ensure that policymakers are aware of the ciplines. The time of theory development and testing was an
power and influence of nurse-led initiatives in healthcare by exciting time when nurse scientists and faculty freely argued
presenting clear theoretical assertions that guide our knowl- about the relevance of particular theories.
edge and practice. Hence, an emphasis on the impact of nurs- Jacqueline Fawcett: A major concern in nursing educa-
ing discipline-specific conceptual models and theories is tion is what I think of as methodological creep, which is far
timely. What matters to us should be how policymakers and too prevalent in nursing research courses across all levels of
other influential factors define nursing and not only be what the curriculum in many nursing programs. This term refers to
nursing science means to nurses. We must convey the influ- an essentially exclusive emphasis on the methods of con-
ence of the context of nursing in advancing nursing science. ducting research (design, sample, instruments, data collec-
We must consider how society (the key players) views nurs- tion procedures, data analysis techniques), rather than
ing. We must explain how nurse scholars use theory to inform focusing on the purpose of research, which is to generate
policy and regulatory stakeholders and clearly articulate the new nursing theories and test existing nursing theories,
implications of nursing research for health policy. guided by nursing conceptual models. Thus, methodological
Phyllis Shanley Hansell: We need to teach students how creep leads to methodological supremacy, where the concep-
nurses can come to the multiprofessional health policy table tual and theoretical components of research are implicit and
with a credible and rigorously developed basic scientific foun- the empirical components reign supreme. I also am con-
dation that is measurably demonstrative of the achievement of cerned about the prevalence of clinical skills supremacy in
optimal patient care outcomes. We have to convey to students undergraduate and graduate clinical courses.
that nursing’s place at the table is as important as caring nurs-
ing practice that deploys a holistic yet unique approach to
patient care whereby the nurse artfully and uniquely integrates
Bright Lights
the components of our metaparadigm (nursing, health, envi- Linda Amankwaa: I recommend that all nursing students
ronment, human beings) to achieve optimal health care out- and graduate nurses learn the meaning of nursing science
comes that are beyond the purview of the other health from the very first nursing course in all nursing programs.
professions. In this era of cost containment, nurses endeavor to There should not be even one nursing program that does not
generate optimal patient care outcomes. Now is the time for include discussion of who we are and what we do. What we
nurses to demonstrate how theory-guided practice substan- do is our nursing science. Do we have time to go back and
tially contributes to high-quality, cost-effective patient care educate all before a crumbling of the discipline? I think so
that ultimately affects patient morbidity and mortality. because I am an optimist, and I care about not just nursing
Rosemary Eustace: Moving forward, we have to theo- but nursing science.
rize about these issues, which matter to what we teach about Marian C. Turkel: All of us must begin to or continue to
nursing science: What is the nature of nursing (identify for- infuse nursing conceptual models and theories into all of our
mation) in contemporary healthcare systems? How do we nursing courses at all levels. I teach a course titled Creating
teach students to develop nursing autonomy? How do nurses Healing Environments for undergraduate nursing students
socialize with their peers? What are the boundaries of each during their last semester. A group project involves presenta-
nursing degree (LPN, ADN, BSN, MS, DNP, PhD), and tion of a healing modality for self or others and to ground the
what do these boundaries mean to cost-effective and effi- presentation within a nursing theory. They do beautiful work
cient health care-related outcomes? What are the evolving and never ask, “Why do we need a nursing theory?”
nursing roles? What are the best ways of preparing nurses Vivien Dee: I think it is important to document where we are
for the evolving roles in healthcare? How are these roles with the use of nursing theories, rather than focus on what we
influencing health outcomes (Liu, Avant, Aungsuroch, may have lost. For example, Spear (2007) found that slightly
Zhang, & Jiang, 2014)? What are the competence-sensitive more than one-quarter (27.1%) of the 207 nursing doctoral dis-
outcomes in nursing (Sasso, Bagnasco, & Watson, 2017)? sertations completed between 2000 and 2004 were based on
How do we socialize nurses to work with other practitioners explicit nursing theories. In addition, Hanna (2016) listed sev-
in multiple-discipline healthcare environments (Lillibridge, eral conferences that were held in 2016 to advance theoretical
Axford, & Rowley, 2000)? knowledge of our discipline. Furthermore, Brennan and Bakken
Pamela N. Clarke: I have serious concerns that nurses in (2015) pointed out that “nursing’s long tradition of theory-
practice, including advanced practice nurses, do not know driven science provides the frameworks that can guide explora-
the knowledge base, the science, or the history of nursing. tions towards promising phenomena and leverage insights into
Understanding nursing history is important because it dem- new knowledge, thereby avoiding the distractions of opportu-
onstrates how nurse scientists initially had to get research nistic exploration” of big data (p. 481). Perhaps even more note-
doctorates (PhD) in other disciplines and how that has influ- worthy is the call for papers addressing theory of nursing science
enced nursing. The early nursing conceptual models and issued in the journal Nursing Research (Henly, 2016).
188 Nursing Science Quarterly 31(2)

Table.  Nursing Conceptual Model and Theory-Guided Dissertation Research at Azusa Pacific University.

Nursing Conceptual Model or Theory Number of Dissertations


King’s Conceptual System 5
Neuman’s Systems Model 8
Orem’s Self-Care Framework 7
Roy’s Adaptation Model 6
Leininger’s Theory of Culture Care Diversity and Universality 1
Parse’s Theory of Humanbecoming 2
Meleis’ Transitions Theory 2
Pender’s Health Promotion Model 1
Hildebrandt and Persily’s Theory of Community Empowerment 1
Watson’s Theory of Human Caring 1

Articulating a clear philosophy, mission, and vision that reflects the uniqueness of nursing knowledge.
Creating a curricular framework, course structures, and teaching-learning approaches that embed concepts from selected nursing theories.
Teaching courses about nursing theories in all four degree programs, differentiated based on the program outcomes and leveled in keeping with previous
knowledge.
Orienting and mentoring new faculty to teach from nursing theoretical perspectives that guide our curricula and approaches to teaching-learning.
Inviting open faculty dialogues in the PhD Committee and retreats about the positions asserted by the authors of the Council for the Advancement of
Nursing Science (CANS) articles published in August, 2015 in Nursing Outlook (Breslin, Sebastian, Trautman, & Rosseter, 2015; Conley et al., 2015;
Grady, 2015; Henly, McCarthy, Wyman, Heitkemper et al., 2015; Henly, McCarthy, Wyman, Stone et al., 2015; Villarruel & Fairman, 2015; Wyman &
Henly, 2015) and the Grace, Willis, Roy, and Jones (2016) article.
Including nursing theoretical frameworks within faculty grant proposals to external funders.
Applying for leadership positions within organizations where we can influence the national agenda.
Seeking greater clarity and specificity about the meaning of caring science and developing methodologies, including instrumentation, to advance the
science.
Focusing faculty and PhD student research within caring science.
PhD courses about: (1) the evolution of the discipline; (2) advancing caring science, and (3) theory development grounded in the discipline of nursing.
Supporting nurse-led centers and faculty practices that are nursing theory-guided practice demonstration projects.
Inviting visiting scholars who have contributed to the theoretical advancement of the discipline to the College.

Figure.  Florida Atlantic University Christine E. Lynn College of Nursing Strategies for Curriculum Development.

Especially encouraging for the future of our discipline’s conceptual-theoretical-empirical structures of nursing
explicit focus on nursing science is my own experience at Azusa research reports for evidence-based practice, and we are
Pacific University, where I have been teaching since 2006. planning to implement a Transitions Framework-based cur-
Since the inception of our PhD in nursing program, 41 students riculum for our undergraduate program. We also offer
have received the doctoral degree. More than four-fifths (83%, courses focusing on nursing conceptual models and theo-
n = 34) of those students used a nursing conceptual model or ries in our master’s degree, Doctor of Nursing Practice, and
theory to guide their dissertation research. As can be seen in the PhD programs.
Table, it is clear that faculty and students have learned to
embrace the use of nursing conceptual models and theories.
Marlaine C. Smith: The tensions between the goals of
Conclusion
seeking external funding and staying true to the disciplinary Rothlyn Zahourek: I remember more than 20 years ago hearing
focus of nursing are palpable in some faculties/communities a panel of esteemed colleagues, some of whom were researchers,
of scholars. In others, the quest to advance nursing as a basic arguing about the value of nursing theory and whether nursing
science has been abandoned already for team science where science exits. The nays claimed that nursing science and nursing
nurse scientists relinquish their theories to advance those of theory were useless and not applicable to the education of and
other disciplines. Our faculty at Florida Atlantic University’s the subsequent needs of practicing nurses. I remember thinking,
Christine E. Lynn College of Nursing has addressed these What is the basis of our profession and our practice if not our
issues in several ways (see Figure). own theories and research based in theory? Are we just applying
Jacqueline Fawcett: I am fortunate to be a faculty the theories of other disciplines? I thought of Nightingale and her
member in a nursing program that includes courses about distinct theories of health, healing, and illness. I thought of
nursing discipline-specific nursing knowledge across all Peplau, who drew on the work of H.S. Sullivan but developed a
levels of the curriculum. For example, our undergraduate theory of interpersonal nursing that affected my 40 years of prac-
nursing research courses emphasize evaluation of nursing ticing psychiatric-mental health nursing.
Fawcett / Essays on Nursing Science 189

Dorothy A. Jones: As we continue to move away from References


nursing science, the future knowledge development and Barrett, E. A. M. (2017). Again, what is nursing science? Nursing
research as well as the preparation of future clinicians and Science Quarterly, 30, 129-133.
our commitment to society all are compromised. It is critical Brennan, P. F., & Bakken, S. (2015). Nursing needs big data and
that nurses reclaim our scientific and theoretical roots now or big data needs nursing. Journal of Nursing Scholarship, 47,
face a future where nursing is no longer an independent prac- 477-484.
tice, in charge of its own destiny and grounded in a scientific, Gebbie, K. M., Wakefield, M., & Kerfoot, K. (2000). Nursing and
research-driven base that generates needed knowledge to health policy. Journal of Nursing Scholarship, 32, 307-315.
serve the well-being of all persons. Hanna, D. (2016). Editorial: A vocation to professional nursing:
The intelligence behind compassion. Research and Theory for
Rosemary Eustace: We need a nursing science revolu-
Nursing Practice, 30, 280-281.
tion, which will definitely require a unified approach in all Henly, S. (2016). Editorial: Three landmark symposia on theory
areas of the nursing profession: education, research, practice, development in nursing. Nursing Research, 65, 1-2.
administration, and policy. Lillibridge, J., Axford, R., & Rowley, G. (2000). The contribution
Jacqueline Fawcett: Readers are invited to share their of nurses’ perceptions and actions in defining scope and stabi-
thoughts about the inclusion of explicit nursing science con- lising professional boundaries of nursing practice. Collegian,
tent in all levels of nursing programs. Do you regard what is 7(4), 35-39.
happening as dark clouds or bright lights? Liu, Y., Avant, K. C., Aungsuroch, Y., Zhang, X. Y., & Jiang,
P. (2014). Patient outcomes in the field of nursing: A con-
Declaration of Conflicting Interests cept analysis. International Journal of Nursing Sciences, 1,
69-74.
The authors declared no potential conflicts of interest with respect Sasso, L., Bagnasco, A., & Watson, R. (2017). Editorial:
to the authorship and/or publication of this review. Competence-sensitive outcomes. Journal of Advanced
Nursing, 73, 1002-1003.
Funding Spear, H. (2007). Nursing theory and knowledge development:
The authors received no financial support for the authorship and/or A descriptive review of doctoral dissertations, 2000-2004.
publication of this review. Advances in Nursing Science, 30(1), E1-E14.
Turkel, M., Fawcett, J., Chinn, P. L., Eustace, R., Hansell, P. S.,
Smith, M., . . . Zahourek, R. (2018). Thoughts about advance-
ORCID iD ment of the discipline: Dark clouds and bright lights. Nursing
Jacqueline Fawcett   https://orcid.org/0000-0002-1091-8873 Science Quarterly, 31, 82-85.