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J Neuromusculoskelet Syst. Author manuscript; available in PMC 2019 September 11.
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Published in final edited form as:

J Neuromusculoskelet Syst. 2000 ; 8(1): 10–15.

The Evolution of Nursing Research

Jacqueline M. Stolley, Ph.D., R.N., C.S.*
Trinity College of Nursing, Moline, Illinois

Kathleen C. Buckwalter, Ph.D., R.N., F.A.A,N.†, Linda Garand, Ph.D., R.N., C.S.‡
University of Iowa, College of Nursing, Iowa City, Iowa
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Abstract
THE RESEARCH CULTURE in nursing has evolved in the last 150 years, beginning with
Nightingale’s work in the mid-1850s and culminating in the creation of the National Institute of
Nursing Research (NINR) at the National Institues of Health (NIH). This article highlights
nursing’s efforts to facilitate the growth of the research culture by developing theory, establishing
the importance of a research-based practice, advancing education, and providing avenues for
dissemination of research. Similarities with the chiropractic profession are discussed, along with a
commentary by Cheryl Hawk, D.C, Ph.D.

Keywords
Nursing education; Nursing research; Nursing theory; Research culture; Research dissemination
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EVOLUTION OF NURSING RESEARCH

The development of a research culture in nursing in many ways parallels that of chiropractic,
and by reviewing key aspects of the evolution of the science of nursing, there are lessons to
be learned, and mistakes to be avoided. Nursing research has changed dramatically in the
past 150 years, beginning with Florence Nightingale in the 19th century. Clearly, nursing
research has not always had the influence and significance it holds today. In fact, for a
number of years after Nightingale’s work, little is found in the literature concerning nursing
research. This is perhaps due to the past perception of nursing as an apprenticeship in a task-
oriented caring profession (1). Although research was conducted with respect to nursing
education and administration in the first half of the 20th century, it was not until the 1950s
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that nursing research began the advancement that has been seen in the past three decades.
This is due to many factors: an increase in the number of nurses with advanced academic
preparation, the establishment of vehicles for dissemination of nursing research, federal
funding and support for nursing research, and the upgrading of research skills in faculty and
students. This article provides a brief review of the development of research in nursing, and
along with it, the theory that has guided that process.

Address correspondence to: Jacqueline Stolley, Trinity School of Nursing, 555 6th St., Suite 300, Moline IL 61265.
*Professor
†Research Associate
‡Professor and Associate Provost for the Health Sciences
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NURSING THEORY DEVELOPMENT

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As with other practice professions, nursing requires a knowledge foundation that is based on
theory and derived from systematic research. The first nursing theorist, Florence
Nightingale, created detailed reports of both medical and nursing matters as chief nurse for
the British in the Crimean War in the mid-1850s. Nightingale noted that “… apprehension,
uncertainty, waiting, expectation, fear of surprise, do a patient more harm than any exertion”
(p. 6) (2). As a result, Nightingale’s conceptualization of nursing included the need to have
an understanding of the laws of nature, the prevention of disease, and the use of personal
power. She viewed persons as both physical and spiritual beings, emphasizing the
importance of the environment and the need to care for the patient, not the disease. With her
emphasis on the environment, changes in nutrition, hydration, and sanitation resulted, and
mortality rates dropped drastically during the Crimean War (3). In subsequent years,
Nightingale developed “laws of nursing” that formed the basis for nursing science and
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guided nursing education in the United States from 1850 to the 1950s (4).

In the 1960s, nursing theory was used to guide teaching rather than research or practice. This
was a natural outgrowth of nursing’s earlier focus on education and professional identity.
Additionally, the National League for Nursing (the professional accrediting body) stipulated
a conceptual framework for curriculum. Paradigmatic concepts integral to nursing were
identified as person, environment, health, and nursing (5–7), and scientific energies were
spent developing curriculum that corresponded to existing theories (7). At this point in time,
nurse educators began to urge students to “care for the whole person” and textbooks
underscored the importance of “holism” in nursing, with subtitles such as “The
Biopsychosocial Approach.” Nurse authors acknowledged multiple causality in human
illness, but all too often research, curricula, and textbooks reflected linear cause-and-effect
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models rather than multivariate approaches.

The 1950s and 1960s saw the development of theories explaining the art and science of
nursing. Hildegard Peplau published Interpersonal Relations in Nursing (8) in 1952, based
on her work as a psychiatric nurse. Other theories. included Levine’s Conservation
Principles of Nursing (9) in, 1967; Roger’s Introduction to the Theoretical Basis of Nursing
(10) in 1970, and The Science of Unitary Man (11) in 1980, followed by The Science of
Unitary Human Beings, a Paradigm for Nursing (12) in 1983. Imogene King published A
Theory for Nursing: Systems, Concepts, Process (13) in 1981, and Sister Calista Roy
published her adaptation model (14) in 1980. These “grand” theories were complex and key
concepts were hard to measure empirically. Thus it was difficult to test these early nursing
theories through research. With the emphasis on clinical nursing research, the recent trend
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has been to develop and test midrange theories that describe patient problems and nursing
practice.

NURSING RESEARCH DEVELOPMENT

In 1859, Nightingale used the battlefield hospitals of the Crimean War as her research
laboratory, using an epidemiological process to describe the morbidity and mortality of sick
and injured soldiers. Her pioneering epidemiological research and statistical methodology

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(documenting the relationship between the environment and health status of soldiers) was
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the hallmark of scientific investigation in nursing (4,15).

An historical review from 1900 to 1949 reveals that nursing research in the United States
(see Table 1) was in its infancy, focusing on nursing education, nurses, nursing students, and
ways to organize nurses’ work. As noted earlier, at this time, nursing theory was discussed
solely as a means of developing and organizing educational curriculum. Early educators
were unable to develop educational programs that both represented a nursing perspective and
helped students focus on nursing concepts and problems rather than medical concepts and
problems. In the first half of this century, groups were formed to answer such questions as:
what is nursing, what do nurses do, and how unique is nursing from other health science
disciplines? Professional debates raged as to whether nursing was merely a “poor stepsister”
of medicine or whether it was part of the biological, natural, or physical sciences (4).
Research during this period was essentially nonexistent in terms of nursing practice.
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It was not until the 1980s that nursing devoted a sizeable portion of its research effort to
patients and patient behavior, an emphasis that emerged logically as nurses began to
recognize the interplay between behavior and rehabilitation or recovery from illness.
Historically, nurses searched for single causative agents when promoting health or
preventing illness, even as they acknowledged the contributions of multiple other factors.
Predominant modes of inquiry relied on early in the development of a culture of nursing
research were empirical (logical positivist). Nurse researchers modeled themselves after
colleagues in the basic and biomedical sciences, perhaps in an effort to seek scientific
validation. Only during the 1980s and 1990s did nurses increasingly use qualitative research
methods, such as phenomenology and ethnography, to explain complex human phenomena.
Therefore, nurse researchers are just beginning to respond to the need to view human
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problems in less reductionistic terms when the research questions call for a holistic
combination of quantitative and qualitative research methodologies (16). Over the past two
decades, many nurses have pursued further education, consultation, or research to enhance
their understanding and ability to respond constructively to patient behavior. For example,
by the mid-1980s, there was a sizable increase in nursing studies of individuals and families
experiencing developmental, environmental, or illness-generated crisis situations involving
both acute and long-term stress responses (17–20).

During the 1990s, nursing practice underwent a clinical revolution in response to societal,
medical, scientific, and technologic advances. Changes in nursing practice began to result
from nursing research (e.g., research-based practice guidelines) as the efforts of individuals
both in and outside of nursing (e.g., National Academy of Science, National Institute for
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Nursing Research, and major foundations) coalesced to stimulate and support clinical
nursing research. Concurrently, there was a new surge of interest among nurses themselves
in redefining the problems of their practice and delineating the gaps in knowledge
underpinning their practice base. As noted earlier, the current decade has been marked by
interest in multiple modes of inquiry (qualitative and quantitative) for a practice discipline
which must address complex human phenomena. In the past, the type of research questions
most often addressed through nursing research were of a descriptive or exploratory nature.
However, nurse researchers are now going beyond “what is” and “how” questions and are

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addressing more explanatory or predictive-level questions using methodologically rigorous

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experimental and quasi-experimental designs as they redefine clinical problems and

systematically address gaps in their knowledge base. After becoming established in the
research arena, nursing researchers have expanded to incorporate and collaborate on
interdisciplinary studies, health care systems and health services research, and taxonomies
such as Nursing Intervention Classification (NIC) (21) and Nursing Outcomes Classification
(NOC) (22). The taxonomies represent efforts to define what nurses do and outcomes
sensitive to nursing interventions.

The culture of nursing research has now advanced to the point where consideration can be
given not just to the conduct of research, but also to its application in practice. The conduct
of research is not the end, but rather a means through which practice is improved by utilizing
research findings. Research utilization is the process of conveying and applying research-
based knowledge to impact or change existing practices in the health care system (23). The
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primary components of research utilization involve summarizing knowledge generated

through research; imparting the research knowledge to nurses, other health professionals,
policymakers, and consumers of health care; and accomplishing desired outcomes for
patients, their families, and health care providers and agencies. Models for research
utilization were developed in the 1970s, beginning with the Western Interstate Commission
for Higher Education in Nursing (WCHEN) Regional Program for Nursing Development
(24). Other models include the Conduct and Utilization of Research in Nursing (CURN)
project (25), the Stetler/Marram model (26), the retrieval and application of research in
nursing (RARIN) model (27) and the Iowa model of research in practice (28). The primary
goal of research utilization programs is to make research findings an integral part of nursing
practice, assuring research-based care delivery models. Research utilization is an excellent
model for application of research findings to practice by advanced practice nurses.
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An important trend is the use of research findings to serve as the basis for treatment decision
making called evidence-based practice (29). Using this process, a question involving
treatment is developed, and determination of the adequacy of current research is made. If the
research base is adequate, it is synthesized, protocols are developed and applied, and
evaluation is completed. Through these efforts, the nursing profession, in partnership with
other professions, bridges the gap between research and practice to improve patient care.

EDUCATIONAL ADVANCEMENT
Early nursing education took place in hospital training programs (nursing diploma), modeled
on Florence Nightingale’s work in the United Kingdom (30). In 1915, nursing’s educational
accrediting body, the National League for Nursing (NLN) called for university-level
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education. Baccalaureate programs in nursing emerged in 1923 at Yale University and

Western Reserve University, but the majority of nursing education took place in hospital-
based diploma programs. In 1971, the first community college programs for nursing
education opened, providing graduates with an associate degree in nursing. Today, entry into
nursing practice takes place primarily in associate degree programs, with baccalaureate
programs second. Gradually, diploma programs have decreased in number, and few exist
today. Associate degree programs may introduce nursing students to research, but

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baccalaureate programs included nursing research in the upper division curriculum. From
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1900 to the 1960s, most nursing leaders obtained their graduate-level preparation in schools
of education (30). For many years, the Master’s degree was considered the terminal degree
in nursing.

The number of nurses whose career was devoted to research was miniscule in the 1960s.
Indeed, even by the 1970s only about 400 nurses in the United States held a doctoral degree
(31). In 1955, the Nursing Research Grants and Fellowship Program of the Division of
Nursing, United States Public Health Service (USPHS) was established. This program
awarded grants for nursing research projects, nursing research fellowships, and nurse-
scientist graduate training (32). Early funding was for nurses to obtain their doctorates in
fields outside of nursing, because there were no nursing doctoral programs available. As a
result, nurse-physiologists, nurse-anthropologists, and so forth emerged in the field. They
were educated to conduct research, but often stayed in the field of their doctorate and did not
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apply their research efforts to nursing care problems.The emphasis during this period
continued to be on establishing nursing’s rightful place in the academic setting of the
university. As nursing became integrated into university life during the 1970s, nursing
faculty became aware of their responsibility to develop new knowledge, and in many
university-based schools of nursing, faculty members began to prepare both themselves and
their students to become investigators (33).

Currently, three types of doctoral degrees in nursing are available. A Nursing Doctorate
(ND), first established at Case Western Reserve University in 1979, was designed to be
equivalent to the Doctor of Medicine degree, providing students preparation for the practice
of generalized nursing and future leadership, but not for advanced practice. Professional
doctorates, Doctor of Nursing Science (DNS, DNSc, DSN), emphasized advanced clinical,
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administrative, or policy-related practice and leadership. The Doctor of Nursing Science

degree focuses on applied rather than basic research, and on applying and testing new
knowledge in practice. Although the Doctor of Philosophy (PhD) was first available to
nurses at Teachers College at Columbia University in the 1920s, interest in doctoral
education was rekindled in the 1970s. The number of doctoral programs in nursing has
increased from zero in the 1950s to over 65 institutions, three-fourths of which are academic
doctorates (PhD) that prepare graduates for a lifetime of scholarship and research (34). More
recently, nurses in academic settings have been encouraged to obtain postdoctoral research
training with support available through both individual (F32) and institutional (T32)
traineeships through the National Institutes of Health (NIH).

RESEARCH FUNDING AND SUPPORT

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Several factors stimulated the growth of nursing research in the 1980s and 1990s. Perhaps
the most important factor was the creation in 1986 of the National Center for Nursing
Research (NCNR) in the United States Public Health Service (USPHS). The development of
this Center resulted from intense political action by the American Nurses’ Association
(ANA) (23). The primary aim of the NCNR was “the conduct, support, and dissemination of
information regarding basic and clinical nursing research, training and other programs in
patient care research” (p. 2) (35). Prior to the establishment of the NCNR, most of the

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federal funds supporting research were designated for medical studies that concentrated on
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the diagnosis and cure of disease. Thus, creation of the NCNR was a major achievement for
nurse researchers. In 1993, the NCNR became the National Institute of Nursing Research
(NINR), strengthening nursing’s position by giving the Center institute status within the
NIH. This advance served to put nursing into the mainstream of research activities and on
more equal status with scientists and other health professions. With the establishment of the
Center and then the Institute, federal funding for nursing research has grown. In 1986, the
NCNR had a budget of $16.2 million. In 1996, the budget for the NINR was about $55
million (1), more than a threefold increase over a decade. The NINR elected to foster five
research priorities for 1995 through 1999: community-based nursing models, effectiveness
of nursing interventions in HIV/AIDS, cognitive impairment, living with chronic illness, and
biobehavioral factors related to immunocompetence (22).

The NINR’s strategic plan for the next millenium includes funding nursing research on
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chronic illnesses (e.g., improving adherence to chemotherapy, pain relief), quality and cost
effectiveness of care, health promotion and disease prevention, management of symptoms
(e.g., gender differences in response to therapeutics, managing the pain cycle), health
disparities (e.g., cultural sensitivity), adaptation to new technologies (e.g., transplants), and
palliative care at the end of life. Special allocations and Requests for Applications (RFA)
have facilitated research in these target areas, although investigator-initiated research topics
are funded if they are significant to nursing or patient care. The projected budget for NINR
for the year 2000 is over $70 million, which is approximately distributed as follows: 73% for
extramural research project grants; 8% for pre- and postdoctoral training; 3.5% for career
development; 3.5% for Core Centers in specialized areas of research inquiry; 3% for the
intramural program. Planning research for the next 5 years and into the next century is a
welcome challenge for the NINR and the scientific community (36).
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RESEARCH DISSEMINATION
Significant milestones in the development of nursing science began in the mid-1950s (see
Table 1). From 1950 to 1959, there was growing emphasis on the need to identify a body of
knowledge for the developing profession of nursing in order to justify its presence in post-
World War II universities (37). Not only was the first journal of Nursing Research
established in 1952; several textbooks related to nursing research were also published.
Another critical step in the evolution of the culture of nursing science was the establishment
of the American Nurses Foundation by the American Nurses Association specifically to
promote nursing research. During the 1950s, regional research conferences were instituted
for the first time, and federal support of nursing research began (4,33,37). All these elements
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were essential to the development of a science of nursing.

Several new nursing research journals, including Applied Nursing Research (ANR), were
instituted in the late 1980s. ANR publishes research reports of special significance to nurse
clinicians (1). Increasingly, clinical specialty (i.e., Heart and Lung, Journal of
Gerontological Nursing) journals are publishing data-based articles as well.

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Another important event in the development and dissemination of nursing theory and
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research was the creation of the Annual Review of Nursing Research in 1983. This
publication includes critical analyses of research pertinent to nursing and health, including
nursing practice, nursing care delivery, nursing education, and the nursing profession.
Chapters systematically assess knowledge development in nursing, encourage the use of
research findings in practice, and provide direction for future research (22). More recently,
scholars have joined to create the Encyclopedia of Nursing Research (38), a publication that
provides a comprehensive overview of research studies, the history of nursing research, and
the evolution of theory development in nursing.

CONCLUSION
The next century challenges nursing research with critical imperatives for improving health
care. Changes in our nation’s population and their needs and expectations will impact the
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direction of nursing research. Consumers are becoming more involved in managing their
own health care, and practitioners are continually adjusting to new technologies as well as
innovative health care systems. The broad spectrum of nursing research encompasses both
clinical and basic investigations with the patient as the central focus. Nursing must
concentrate on making certain that our valuable scientific findings are incorporated into
practice and focus on developing the next generation of nurse researchers (36).

The research culture in chiropractic is similar to where nursing research was in its early
years. To move chiropractic research forward will require many of the same changes that
occurred in nursing, such as educational advancement, collaboration in academic settings,
federal acknowledgement and support, and development of more avenues for research
dissemination to practitioners. Just as nursing had to overcome significant barriers such as
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attitudes and low educational and professional status, so, too, will the chiropractic profession
have to strive to develop a research tradition in order to integrate research as part of its
practice culture.

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TABLE 1.

Nursing: Historical Developments in Nursing Theory and Research

Date Development
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1850 Florence Nightingale: first nurse researcher; first nurse theorist

‘Dark Ages’
Late 1800s–1900 Nursing viewed as an apprenticeship
Little focus on research-based practice
American Journal of Nursing (AJN) published
Research focus: nursing education and administration
1900–1949
Questions: What is nursing? What do nurses do? How is nursing unique?
Debates: nursing vs. medicine as separate disciplines
Growing emphasis on need to identify a body of nursing knowledge
Nursing Research journal established (1952)
1950s
American Nurses Foundation
Federal support for funding
Number of nurse researchers miniscule
Early funding for nursing doctorate education — “hyphenated nurse”
1960s Emphasis on nursing’s rightful place in the university setting
Nursing theory to guide practice: person, environment, health, and nursing
Beginning of “Grand” Theory development
Nursing educators aware of need to develop new knowledge
American Nurses’ Association (ANA) Commission on Nursing Research
1970s Journals published: Research in Nursing and Health, Advances in Nursing Science, and
Western Journal of Nursing Research
Increase in doctoral programs in nursing education

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Conduct and Utilization of Research in Nursing (CURN) project published
National Center for Nursing for Nursing Research (NCNR) established within the
National Institutes of Health (NIH)
1980s
Journals published: Annual Review of Nursing Research and Applied Nursing Research
Research focus: patients and patient behavior
Empirical modes of inquiry (logical positivitist)
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Date Development
Beginnings of qualitative research (phenomenology and ethnography
Better preparation for nurse researchers
Federal funding $16.2 million at NCNR
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Healthy People 2000 published

Clinical Practice Guidelines (AHCPR)
Clinical Nursing Research journal published
NCNR renamed the National Institute for Nursing Research (NINR) in 1993
Nursing doctoral programs in 65 institutions
1990s Emphasis on clinical research
Research-based practice-research utilization, evidence-based practice
Multiple modes of inquiry
Emphasis on explanatory and predictive-level studies (vs. descriptive and exploratory)
Encyclopedia of Nursing Research published in 1998
Federal funding $55 million at NINR
Community-based nursing models
1995–1999
NINR research priorities: effectiveness of nursing interventions in HIV/AIDS; cognitive impairment; living with chronic illness; biobehavioral factors related to immunocompetence
Chronic illnesses
2000 NINR research priorities: quality and cost effectiveness of care; health promotion and disease prevention; management of symptoms; adaptation to new technologies; health
disparities; palliative care at the end of life budget: over $70 million

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