755734

research-article2018
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
journals.sagepub.com/home/nsq

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
second that was written in response to Barrett’s (2017)
“Again, What Is Nursing Science?” The authors were pro-
voked to respond with their thoughts about our discipline,
which was published in the previous issue of Nursing Science
Quarterly (Turkel et al., 2018). The essay in this issue of
Nursing Science Quarterly is a compendium of the authors’
thoughts about the contemporary focus of nursing curricula.
As in the previous essay, the responses were categorized as
dark clouds and bright lights.
Dark Clouds
Linda Amankwaa: The debate about questions such as
“What is nursing science?” “Who cares?” and “Who knows?”
(Barrett, 2017) is one that only the nursing elite get to dis-
cuss. Think for a moment. Who can even participate in the
debate? Why fully a majority of those whose license contains
the word nurse cannot participate is because the phrase nurs-
ing science may be mentioned, but its importance is not
emphasized in the curricula of all nursing programs. I would
venture to say that nursing science is not even mentioned in
some nursing programs. Yet we expect some semblance of
connectedness around the topic of science of nursing or nurs-
ing science among nurses.
I maintain that all nurses should know or at least be
exposed to their science and the term nursing science. If this
is what we do, then why shouldn’t we, all of us, be doing
1
Associate Professor, Christine E. Lynn College of Nursing, Florida
Atlantic University, Boca Raton, FL, USA
2
Professor, Department of Nursing, University of Massachusetts, Boston,
MA, USA
3
Associate Professor, Nursing, Albany State University, Albany, GA, USA
4
Professor/Executive Nurse Leader Fellow, University of Wyoming Fay
W. Whitney School of Nursing, Laramie, WY, USA
5
Professor, Doctoral Nursing Programs, School of Nursing, Azusa Pacific
University, Azusa, CA, USA
6
Associate Professor, College of Nursing and Health, Wright State
University, Dayton, OH, USA
7
Professor, Seton Hall University, South Orange, NJ, USA
8
Professor of Nursing, Boston College, Director Emerita and Senior
Nurse Scientist, Yvonne L. Munn Center for Nursing Research, William F.
Connell School of Nursing, Chestnut Hill, MA, USA
9
Dean and Helen K. Persson Eminent Scholar, Christine E. Lynn College
of Nursing, Florida Atlantic University, Boca Raton, FL, USA
10
Belchertown, MA, USA
186 Nursing Science Quarterly 31(2)
“nursing science”? Other questions to ask are: If we are
nurses and we have a nursing science, when do we expose a
nurse to the science? Who decided this? If Nightingale wrote
the beginnings of our science, is this not the science of all
nurses including but not limited to those with the word nurs-
ing in their license? We must question why our discussion of
nursing science begins at the end of the road (such as in nurs-
ing doctoral programs) and not at the beginning (at the start
of prelicensure programs). It is hard to convince everyone if
we have not educated them.
Pamela N. Clarke: I have sampled top ranked nursing
schools and examined their curricula. Very few programs
were solidly based on nursing theory and science with a clear
picture of nursing knowledge. A large number of programs
refer to theories and evidence-based outcomes, but it is not
clear whether the evidence is from nursing science or other
disciplines. Some have courses on theories related to nurs-
ing, but there is little about nursing theories that can be deter-
mined from looking at websites. There is more attention to
interprofessional practice than to nursing theory-driven prac-
tice. Few programs consistently emphasize nursing concep-
tual models and theories from the beginning of the curriculum
to help students build their nursing knowledge within the
context of the discipline. How much better it would be to
have nurses who go beyond physician orders so that gradu-
ates can approach people as nurse theorists with a vision and
clear understanding of nursing knowledge. Are advanced
practice nurses practicing advanced nursing or mini-medi-
cine? Is it ethical to portray to the public that the provider
will use advanced practice nursing knowledge when the
main focus is diagnosis and treatment? Or do we take the
position that consumers will not know the difference so it is
not necessary to explain what nursing is, separate from medi-
cine? How does the nurse participant on a team in any setting
portray that which is unique—that is, the holistic knowledge
approach that underlies nursing practice?
Rothlyn Zahourek: Barrett (2017) has underscored the
trend of not teaching the nursing conceptual models and the-
ories that have been successfully used for several decades.
What a shame. Of great concern to me is that no longer are
we teaching these nursing conceptual models and theories in
undergraduate or graduate programs; now it appears that
nursing science is regarded as having little or no relevance
for scholarly work. Yet without knowledge and appreciation
of nursing science, which also forms and illuminates our his-
tory, all levels of students will miss learning the basis of our
profession. Without nursing theory-guided research and the
subsequent science, we become a trade whose members care
for others, promote health, and who are not professional but
instead are ancillary and placed into the despised category of
“midrange practitioners.”
Marian C. Turkel: It is alarming to look at nursing cur-
ricula from some major universities and see that nursing
theory courses are not part of the curriculum at any level of
education. How will the future of nursing discipline-specific
knowledge, nursing theory, and nursing science be advanced
when it is not part of the curriculum? If doctoral dissertations
are not informed by nursing theory, how will research related
to nursing science be advanced?
Pamela N. Clarke: Indeed, where is nursing science in
doctoral programs? Some schools introduce nursing science
at the doctoral level. Language tends to be confusing, refer-
ring to clinical leadership to improve and transform health-
care. Would that not be true for pharmacists and other
providers? Are these doctoral students not also responsible
for improving and transforming nursing science? Leadership
is the trendy concept, but how can nurses possibly lead with-
out nursing knowledge?
Rothlyn Zahourek: I share Barrett’s (2017) concern
about the split of emphasis and two distinct paths occurring
in nursing doctoral programs. One path emphasizes nursing
as an applied science based on the theories from other disci-
plines, and therefore, interdisciplinary and team research is
emphasized. The other path emphasizes nursing theory-
based research that supports the view that nursing is a sci-
ence and a discipline unto itself.
Jacqueline Fawcett: Which is the better path? For what
purpose is that the better path?
Dorothy A. Jones: Barrett’s (2017) article is both timely
and brings attention to an issue that threatens the future of
nursing knowledge development. As she so clearly reinforces,
our disciplinary perspective, our science, is being lost to the
infusion of an interdisciplinary focus that continues to obscure
the unique contributions of nursing science to the global com-
munity that nurses serve. The threat of this shift is most obvi-
ous in an increasing number of our doctoral programs where
the development and refinement of nursing knowledge is
being replaced by theoretical guides from other disciplines
with a goal that differs from that of nursing. This trend affects
undergraduate and master’s degree education, where the dis-
semination of nursing conceptual models and theories and
essential substantive content is being replaced or at best
blurred in its importance … nice to know but not necessary.
Rosemary Eustace: As a nurse scholar and educator, I
find it very disturbing when I hear students voice their frustra-
tions about nursing theory as they ask: “Are we really going
to use this in nursing practice? When I was in the hospital, I
did not see nurses using any theory to take care of my loved
one; they just did what they were supposed to do!” Similarly,
I have heard some faculty express these opinions about nurs-
ing theory: “We do not need a theory class!” “Undergraduates
are not going to do research, so they do not need a theory
class.” “Nursing theories are old, no one cares about them
nowadays, we used them during the old days to guide our cur-
riculum!” “I will teach my own theories in my clinical
courses; my graduate students do not need a class on nursing
theory!” “We don’t have a PhD program, so we do not need a
separate nursing theory class!” I contend that as the largest
healthcare profession, we have to overcome historical, regu-
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
patient health outcomes (Gebbie, Wakefield, & Kerfoot,
2000). We have to ensure that policymakers are aware of the
power and influence of nurse-led initiatives in healthcare by
presenting clear theoretical assertions that guide our knowl-
edge and practice. Hence, an emphasis on the impact of nurs-
ing discipline-specific conceptual models and theories is
timely. What matters to us should be how policymakers and
other influential factors define nursing and not only be what
nursing science means to nurses. We must convey the influ-
ence of the context of nursing in advancing nursing science.
We must consider how society (the key players) views nurs-
ing. We must explain how nurse scholars use theory to inform
policy and regulatory stakeholders and clearly articulate the
implications of nursing research for health policy.
Phyllis Shanley Hansell: We need to teach students how
nurses can come to the multiprofessional health policy table
with a credible and rigorously developed basic scientific foun-
dation that is measurably demonstrative of the achievement of
optimal patient care outcomes. We have to convey to students
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
the components of our metaparadigm (nursing, health, envi-
ronment, human beings) to achieve optimal health care out-
comes that are beyond the purview of the other health
professions. In this era of cost containment, nurses endeavor to
generate optimal patient care outcomes. Now is the time for
nurses to demonstrate how theory-guided practice substan-
tially contributes to high-quality, cost-effective patient care
that ultimately affects patient morbidity and mortality.
Rosemary Eustace: Moving forward, we have to theo-
rize about these issues, which matter to what we teach about
nursing science: What is the nature of nursing (identify for-
mation) in contemporary healthcare systems? How do we
teach students to develop nursing autonomy? How do nurses
socialize with their peers? What are the boundaries of each
nursing degree (LPN, ADN, BSN, MS, DNP, PhD), and
what do these boundaries mean to cost-effective and effi-
cient health care-related outcomes? What are the evolving
nursing roles? What are the best ways of preparing nurses
for the evolving roles in healthcare? How are these roles
influencing health outcomes (Liu, Avant, Aungsuroch,
Zhang, & Jiang, 2014)? What are the competence-sensitive
outcomes in nursing (Sasso, Bagnasco, & Watson, 2017)?
How do we socialize nurses to work with other practitioners
in multiple-discipline healthcare environments (Lillibridge,
Axford, & Rowley, 2000)?
Pamela N. Clarke: I have serious concerns that nurses in
practice, including advanced practice nurses, do not know
the knowledge base, the science, or the history of nursing.
Understanding nursing history is important because it dem-
onstrates how nurse scientists initially had to get research
doctorates (PhD) in other disciplines and how that has influ-
enced nursing. The early nursing conceptual models and
theories were developed to help focus the discipline on nurs-
ing science, rather than merely using the science of other dis-
ciplines. The time of theory development and testing was an
exciting time when nurse scientists and faculty freely argued
about the relevance of particular theories.
Jacqueline Fawcett: A major concern in nursing educa-
tion is what I think of as methodological creep, which is far
too prevalent in nursing research courses across all levels of
the curriculum in many nursing programs. This term refers to
an essentially exclusive emphasis on the methods of con-
ducting research (design, sample, instruments, data collec-
tion procedures, data analysis techniques), rather than
focusing on the purpose of research, which is to generate
new nursing theories and test existing nursing theories,
guided by nursing conceptual models. Thus, methodological
creep leads to methodological supremacy, where the concep-
tual and theoretical components of research are implicit and
the empirical components reign supreme. I also am con-
cerned about the prevalence of clinical skills supremacy in
undergraduate and graduate clinical courses.
Bright Lights
Linda Amankwaa: I recommend that all nursing students
and graduate nurses learn the meaning of nursing science
from the very first nursing course in all nursing programs.
There should not be even one nursing program that does not
include discussion of who we are and what we do. What we
do is our nursing science. Do we have time to go back and
educate all before a crumbling of the discipline? I think so
because I am an optimist, and I care about not just nursing
but nursing science.
Marian C. Turkel: All of us must begin to or continue to
infuse nursing conceptual models and theories into all of our
nursing courses at all levels. I teach a course titled Creating
Healing Environments for undergraduate nursing students
during their last semester. A group project involves presenta-
tion of a healing modality for self or others and to ground the
presentation within a nursing theory. They do beautiful work
and never ask, “Why do we need a nursing theory?”
Vivien Dee: I think it is important to document where we are
with the use of nursing theories, rather than focus on what we
may have lost. For example, Spear (2007) found that slightly
more than one-quarter (27.1%) of the 207 nursing doctoral dis-
sertations completed between 2000 and 2004 were based on
explicit nursing theories. In addition, Hanna (2016) listed sev-
eral conferences that were held in 2016 to advance theoretical
knowledge of our discipline. Furthermore, Brennan and Bakken
(2015) pointed out that “nursing’s long tradition of theory-
driven science provides the frameworks that can guide explora-
tions towards promising phenomena and leverage insights into
new knowledge, thereby avoiding the distractions of opportu-
nistic exploration” of big data (p. 481). Perhaps even more note-
worthy is the call for papers addressing theory of nursing science
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
explicit focus on nursing science is my own experience at Azusa
Pacific University, where I have been teaching since 2006.
Since the inception of our PhD in nursing program, 41 students
have received the doctoral degree. More than four-fifths (83%,
n = 34) of those students used a nursing conceptual model or
theory to guide their dissertation research. As can be seen in the
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
seeking external funding and staying true to the disciplinary
focus of nursing are palpable in some faculties/communities
of scholars. In others, the quest to advance nursing as a basic
science has been abandoned already for team science where
nurse scientists relinquish their theories to advance those of
other disciplines. Our faculty at Florida Atlantic University’s
Christine E. Lynn College of Nursing has addressed these
issues in several ways (see Figure).
Jacqueline Fawcett: I am fortunate to be a faculty
member in a nursing program that includes courses about
nursing discipline-specific nursing knowledge across all
levels of the curriculum. For example, our undergraduate
nursing research courses emphasize evaluation of nursing
conceptual-theoretical-empirical structures of nursing
research reports for evidence-based practice, and we are
planning to implement a Transitions Framework-based cur-
riculum for our undergraduate program. We also offer
courses focusing on nursing conceptual models and theo-
ries in our master’s degree, Doctor of Nursing Practice, and
PhD programs.
Conclusion
Rothlyn Zahourek: I remember more than 20 years ago hearing
a panel of esteemed colleagues, some of whom were researchers,
arguing about the value of nursing theory and whether nursing
science exits. The nays claimed that nursing science and nursing
theory were useless and not applicable to the education of and
the subsequent needs of practicing nurses. I remember thinking,
What is the basis of our profession and our practice if not our
own theories and research based in theory? Are we just applying
the theories of other disciplines? I thought of Nightingale and her
distinct theories of health, healing, and illness. I thought of
Peplau, who drew on the work of H.S. Sullivan but developed a
theory of interpersonal nursing that affected my 40 years of prac-
ticing psychiatric-mental health nursing.
Fawcett / Essays on Nursing Science 189
Dorothy A. Jones: As we continue to move away from
nursing science, the future knowledge development and
research as well as the preparation of future clinicians and
our commitment to society all are compromised. It is critical
that nurses reclaim our scientific and theoretical roots now or
face a future where nursing is no longer an independent prac-
tice, in charge of its own destiny and grounded in a scientific,
research-driven base that generates needed knowledge to
serve the well-being of all persons.
Rosemary Eustace: We need a nursing science revolu-
tion, which will definitely require a unified approach in all
areas of the nursing profession: education, research, practice,
administration, and policy.
Jacqueline Fawcett: Readers are invited to share their
thoughts about the inclusion of explicit nursing science con-
tent in all levels of nursing programs. Do you regard what is
happening as dark clouds or bright lights?
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect
to the authorship and/or publication of this review.
Funding
The authors received no financial support for the authorship and/or
publication of this review.
ORCID iD
Jacqueline Fawcett   https://orcid.org/0000-0002-1091-8873
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