- May 2012 - Volume 112 - Issue 5 - p 48–55doi: 10.1097/01.NAJ.0000414321.10073.c8Feature Articles
Key Ideas in Nursing's First Century
Baer, Ellen Davidson PhD, RN, FAANAuthor Information
Ellen Davidson Baer is professor emerita at the University of Pennsylvania School of Nursing, Philadelphia, and cofounder and former associate director of the university's Barbara Bates Center for the Study of the History of Nursing. Contact author: ellendbaer@aol.com. The author has disclosed no potential conflicts of interest, financial or otherwise.Abstract
OVERVIEW: This article identifies some of the major ideas underpinning modern American nursing in its first 100 years, and postulates that distinct periods in nursing's early formal development were dominated by a particular theme or set of ideas. The themes, which were largely determined by social priorities, scientific advances, and national emergencies, overlapped, enriched each other, and provided an impetus for nursing to evolve into the highly skilled profession it has become.With America's transformation following the Civil War from an agrarian society to an industrial state, much of the care of the sick, formerly provided by relatives in the privacy of a home or village, was performed by strangers in public institutions. Social reformers, such as Abby Howland Woolsey, sought to create a reliable workforce that could meet people's need for basic sick care, safety, and protection in those institutions.1
Figure. Bandage roll...
Figure. A nurse care...Social assumptions about gender, race, and class are woven throughout nursing's first century. The female social role provided the domestic model on which nursing was built.2 Wealthy patrons visualized domestic workers performing the more laborious, “dirty” tasks under the supervision of a more educated “lady” nurse.3 But within a generation, such nursing leaders as Isabel Hampton Robb had replaced the wealthy patrons, and nursing began to manage itself, expanding its breadth and depth of knowledge over subsequent decades.3, 4 Born out of a concern for patient safety and shaped by an appreciation of domestic skills, scientific knowledge, professionalism, pedagogy, nurturance, compassion, research, and theory, nursing could no longer be perceived merely as “work performed by nice people.” Within its first 100 years, the profession of nursing had unquestionably evolved into one that employed highly skilled experts to provide lifesaving and technical care to people who were ill or injured.
Figure. Pediatric NP...
Figure. NP Loretta F.PATIENT SAFETY, KNOWLEDGE, AND REFORM
“When the visitor entered the ward … a little boy of five years old had just been operated upon for stones in the bladder, an old woman [a patient] was sitting by him trying good naturedly to soothe his cries but doing nothing to staunch the blood which was flowing from the wound.5”This quote from Elizabeth Hobson's Bellevue Hospital Visiting Committee notes of 1872 reflects the author's concern with patient safety, the primary goal underlying the adoption of formal nursing in the United States. Overwhelmed, chaotic, and underfunded public institutions had become prime targets for the reform efforts of well-meaning citizens whose consciences had been awakened by the Civil War. One such group of reformers was the Visiting Committee of Bellevue Hospital, of which Hobson was a member. But Hobson's observation also underscores the importance of a second concept central to nursing's foundation: knowledge, having the information required in order to “staunch the blood which was flowing from the wound.” Finally, Hobson's very presence in the hospital ward testifies to a third seminal idea in modern nursing: reform, the desire of citizens to improve the social services provided, or, more typically, not provided, to needy citizens. The “age of reform,” as this period was described by historian Richard Hofstadter in his book by the same name, had come to American hospitals.6A decade or two earlier, Florence Nightingale had written that nursing “ought to signify the proper use of fresh air, light, warmth, cleanliness, quiet and the proper selection and administration of diet—all at the least expense of vital power to the patient.”7 In Hobson's time, the main knowledge underlying care of the sick was related to such domestic matters as hygiene, nutrition, various poultices, rest, and potions built around alcohol or opium derivatives, the benefits of which were mainly to numb the pain rather than cure the malady.Of hygiene practices at one public institution, Hobson wrote, “The visitor found a woman with a broken leg twelve days after she had been brought to the hospital in the same miserable garments in which she fell.”5 In describing an almshouse (poorhouse) hospital, she said, “The condition of the patients was unspeakable; the one [untrained] nurse slept in the bathroom, and the tub was filled with filthy rubbish.”1On the subject of nutrition, Hobson recounted a Friday meal in the same hospital, wherein “the dinner of salt fish was brought in a bag to the ward and emptied on to the table; the convalescents helped themselves, and carried to the others their portions on a tin plate with a spoon.” She described the kitchen as follows:“A … cook was ladling out soup into great tin basins which the workhouse women were to take up to the wards, and I learned that those same cauldrons were used for the tea and coffee in the morning. Some pauper women were huddled together in a corner, peeling potatoes, and the whole place reeked with the smell of foul steam and food. I had to escape, it was too dreadful!1”Because sick people had traditionally been cared for by female family members, women had developed strong information networks, passed down from mother to daughter, usually in verbal form. Based on her observations, Hobson concluded that the workers she had observed in institutions often lacked the domestic skills farm and town women had used to manage their private households. Hospitals needed workers who could clean patients and wards, prepare and serve decent meals, launder clothes and bedding, and petition administrators to purchase such necessary supplies as soap, clean linens, bandages, proper food, and other household products—all of which fit within the realm of skills taught to most women from birth.2 As Nightingale wrote in the late 1800s, “Every woman … has, at one time or another of her life, charge of the personal health of somebody, whether child or invalid—in other words, every woman is a nurse.”7DOMESTIC SKILLS
To correct the deficiencies of the sick care system, Hobson and her fellow Visiting Committee members started the Training School for Nurses at New York City's Bellevue Hospital in 1873, attempting to base it on Nightingale's work in England. Similar schools opened in Massachusetts and Connecticut later that year.8 All of these schools functioned as nursing-service delivery agencies in the hospitals with which they were affiliated. Pupils delivered care, while instructors supervised and, when time permitted, taught minimal basic nursing skills, such as bandaging and poulticing. From the outset, the schools struggled with the double obligation of trying to ensure patient safety while teaching fledgling nurses what they needed to do to reform the institutions. Ultimately, their solution was to recruit women “of character” with domestic capabilities, while developing “rigid rules and detailed procedures” that created order and served to “protect patients from harm.”9Susan Reverby created a play on words to capture this conundrum in her historical work, Ordered to Care: The Dilemma of American Nursing, 1850-1945.10 Its title reflects the idea that society had ordered nurses to provide care to hapless patients, while also conveying the notion that nurses could provide care only if they first achieved order in the chaotic institutions in which the sick resided. The entire first generation of formally trained nurses focused on that task: bringing order to the institutions and systems of care while establishing the purview of nurses on the basis of domestic knowledge available to ordinary women. Some, like Nightingale, saw themselves as sanitarians. Others, like Linda Richards, saw themselves as missionaries, infused with evangelical enthusiasm.11 By the late 1800s, however, domestic knowledge was no longer adequate to the task of nursing.THE INFLUENCE OF SCIENCE
Scientific knowledge, gained in the bacteriologic laboratories of Europe, began to influence American medical and nursing practices by the close of the 19th century. In Europe, Ignaz Semmelweis reduced childbed fever by 90% in the 1840s merely by insisting on handwashing.12 In 1864, Louis Pasteur introduced the germ theory, and Joseph Lister began using carbolic acid to clean wounds.12 In 1882, Robert Koch saw tuberculosis bacteria under a microscope, and by 1890, ether, morphine, digitalis, diphtheria antitoxin, smallpox vaccine, iron, quinine, iodine, alcohol, and mercury were the 10 most important medicines in use.12 Although the germ theory had not yet been accepted by society (or by Nightingale, who rejected it her entire life),10 the need for nurses to know and apply new scientific information became apparent.The Johns Hopkins Hospital opened in 1889 with a training school for nurses directed by Isabel Hampton. When its medical school opened in 1893, Hopkins became the first American medical institution to include training in the sciences of bacteriology, chemistry, pathology, and physiology and to focus these growing bodies of knowledge on the day-to-day management of patient care. At the opening ceremonies for the training school,the hospital's superintendent, Dr. Henry M. Hurd, assured the gathering that in this training school, “service in the Accident Department and in the Dispensary; in the Medical, Surgical, Gynaecological and Pay Wards” would be accompanied by “carefully devised courses of study and systematic mental training…. In the eyes of the Trustees,” he added, “nursing the sick is not to be considered a trade but a learned profession.”13PROFESSIONALISM
In its third decade as a formally trained occupation in the United States, nursing embraced the idea of professionalism in relation to its developing scientific knowledge base. Teaching became more intense and nursing instructors became interested in perfecting specific nursing care delivery systems, identifying methods of instruction, establishing curriculum standards, certifying the equivalence of nursing programs, registering graduates as licensed nurses, forming associations, and establishing higher education courses for teachers and administrators. The training schools had been so successful in organizing the hospitals that every hospital wanted one. Within the first 20 years of modern nursing, the number of training schools increased rapidly.8 Some of these so-called “training schools” opened in doctors’ private homes, where sometimes up to four patients resided. Since such a limited situation couldn't provide nurses anything approaching a well-rounded curriculum, the national body of nursing superintendents—through their organization, the American Society of Superintendents of Training Schools for Nurses, later known as the National League for Nursing (NLN)—sought to rectify the situation by clearly defining the term “trained nurse.” The Chicago World's Fair of 1893 offered nursing the perfect stage on which to address such issues.The superintendents’ society credited Ethel Bedford Fenwick of England with suggesting the inclusion of a nursing section at the World's Fair.8 Fenwick led an English group that was seeking to organize and register nurses—against the wishes of Nightingale, who fought professionalizing strategies her entire life, believing them to be contrary to the concept of nursing as a calling. Fenwick knew the American nurse leaders shared her views and, in promoting their inclusion in the World's Fair, she sought a wider audience for those views. When the idea for developing a nursing subsection of the International Congress of Charities, Corrections, and Philanthropy was introduced, John Shaw Billings of Johns Hopkins, who chaired the hospital and medical section of the congress, appointed his Hopkins colleague, Isabel Hampton, as chair.Many of the Nightingale convictions—such as the idea that nursing was a calling that could not be credentialed, registered, or licensed—and traditions—such as the practice of having hospital nursing matrons identify alumnae who demonstrated the calling to nursing—faded as American and Canadian nurses at the World's Fair presented newer, more independent professional ideas, rooted in a respect for science and a belief in education (see Presentations by Nurses at the Chicago World's Fair of 18933).3 In these presentations and the discussions that followed them, the framework for a new view of nursing was articulated by the superintendents of the larger schools, whose opinions and programs dominated the events.3, 14 In presenting their concerns to a wide audience on a world stage, the leaders hoped to demonstrate the importance of nursing work and the difficulties nurses confront in performing their work. Nursing work still centered on patient safety, but now nurses sought the legitimation of their work through licensure, accreditation, and other forms of societal approbation.PEDAGOGYThe 1893 World's Fair would influence teaching methods in the training schools for generations to come. The superintendents’ society called its first meeting in 1894 and began the work of evaluating nursing education, which remains a focus of today's NLN. At its second meeting, Hampton presented a paper entitled “The Three Years’ Course of Training in Connection with the Eight Hour System,” linking nursing to labor reform movements that were spreading throughout other industries.15 This was not new ground for Hampton—her speech at the World's Fair had called for a uniform curriculum for all nursing schools and her first book documented the plan,4 advocating for a three-year nursing curriculum in its 1899 edition and for a probationary period for new pupil nurses in its 1911 edition.Alumnae associations of the various schools grew in number and, in 1896, joined to become the Nurses’ Associated Alumnae of the United States and Canada, which was renamed the American Nurses Association in 1911. Hampton's hope was that alumnae associations would offer nurses a means of banding together to seek better wages, hours, and working conditions after they had graduated and no longer had instructors to represent them.4Eventually, Hampton and Adelaide Nutting, who was then assistant superintendent at Hopkins, worked together to create graduate education courses for the teachers and administrators. As Hampton (who married Hunter Robb, an obstetrician and gynecologist at Johns Hopkins, and changed her name to Isabel Hampton Robb in 1894) argued:“It is generally conceded by instructors in other kinds of schools that in addition to the diploma secured, it is necessary for those who intend to teach to have a further course in a school of pedagogy or in a Normal school where they may supplement the knowledge they have acquired by learning the principles and the best methods of teaching and how to apply them. Why should not this hold equally well with a woman who elects to become a teacher in a school for nurses?16”Within two years of publication, the course described by Hampton Robb for nursing teachers was introduced at Teachers College of Columbia University in New York City. Called a course in “Hospital Economics,” the program began with seven students taught by Anna Alline. In 1907, Nutting left her position at Hopkins to take over the graduate course, which was endowed by Helen Hartley Jenkins in 1909 and renamed the Department of Nursing and Health.13, 17These events supported the idea of standardization—for curricula, teacher training, and nurse training, all of which were necessary “to assure the public that nurses [would] conduct themselves in such a way that the public [could] have confidence in their work.”9 Hampton Robb was a primary force behind these movements. A Canadian teacher prior to becoming a nurse, Hampton Robb had what Nutting described as a “love of uniformity.”18 Unlike Nightingale, who sought women with a calling, who would know innately what was right to do and do it, Hampton Robb attempted to impose that character through rules and standards, rote learning, and what she later called “ethics,”19 a term she used to describe such qualities as respect, discipline, and what we might today call “manners.”At the time formal nurse training began in America, most professions and many skills were taught through a system of apprenticeship. Doctors, lawyers, farmers, bankers, teachers, and even mothers learned their skills alongside an expert. Novices apprenticed themselves to willing sponsors, who directed their reading and shared their expertise as the pupil participated in actual cases. Nursing's adoption of this technique made sense in its infancy and early years but not necessarily in the early 1900s, as other disciplines moved toward university study. Some nursing programs opened in universities, but as nurse leaders clung to the old model of training, the vast majority of schools remained embedded in the hospitals, in systems associated with vocational training rather than higher education.12NURTURANCE AND COMPASSION
Although nurturance has always been understood as a part of nursing care, such qualitative attributes were not specifically taught in training courses until after World War II, when Hildegard Peplau introduced interpersonal process to nursing education. Nightingale had believed that the right kind of women, through their calling, brought such characteristics with them into formal nursing roles. But she also described some behaviors, desirable in nurses, that compose what we now call caring: ridding patients of “apprehension, uncertainty, waiting, expectation, fear of surprise”; assuring them of an “organized system of attendance”; preventing “unnecessary noise” and “thoughtlessness”; “always sit[ting] within the patient's view”; “let[ting] your thought expressed to them be concisely and decidedly expressed,” since they will find doubt and hesitation upsetting.7At Hopkins, Dr. Henry Hurd wanted to create “the development of kindly instincts and humane methods of thought among all employés [sic]” and believed that nursing should impart “sympathy, kindly feeling, enthusiasm and personal interest,” with the nurse “happy and contented in her chosen calling.”13Coinciding with the World's Fair events of 1893, Lillian Wald opened her Henry Street Settlement House on New York City's Lower East Side. According to the research of nurse historian Diane Hamilton, “Settlement houses, as outposts of education and culture within depraved cities, were intended to bridge the gulf between the classes, to lessen suspicion and hostility between diverse cultural groups, and to do more than just ‘hand out’ charity.”20 When Lavinia Dock and Annie Goodrich joined forces with Wald at Henry Street, they merged “ideas of reform, progress, womanhood, justice and the public's health” into their construct of what nursing could and should be and wove it into a larger view of health, one that encompassed social progress and responsibility for the entire public.20 Later, “their memoirs [would] reveal that nursing provided them with an opportunity for a personal relationship with others, a way of encountering humanity in a face-to-face relationship, and a way of doing good works through the care of needy persons…. Compassion … became an expected attitude … within the context of Henry Street Settlement House.”20 In their view, at the turn of the century, compassion was the fundamental idea behind nursing.“Compassion was not sentiment, but making justice and doing works of mercy. Compassion was not a favor to the poor, but something to which patients had a right, and for the nurse, an opportunity. Compassion was not pity, but celebration of the kinship of the human spirit. Compassion was not private, but public service. Compassion was not simply knowing about the suffering of others, but entering into it, sharing it, and understanding it. Compassion was not anti-intellectual, but sought to know and understand the interconnections of all things. Compassion was not a commandment, but a spirituality that treated all creation with respect. Compassion was not an organized religion, but it was, for the nurse inventors, a way of life.20”RESEARCH
In 1926, 25 U.S. colleges and universities granted bachelor of arts or bachelor of science degrees in nursing, but their combined enrollment was only 368, compared with the 10,000 U.S. nurses who graduated from hospital diploma schools each year.12 Because university faculty required advanced degrees, nursing instructors often sought training at Teachers College of Columbia University, where they were exposed to research, read scientific studies, and learned research methods. Some of the studies they read were directly related to nursing.Following the model created by Abraham Flexner when he studied the structure of medical education in 1910, nursing (with some funding support) commissioned its own studies during the first half of the 20th century. During this period, nursing was also shaped by such world events as the Spanish-American War, World War I, women's suffrage, the Great Depression, and World War II.The wars greatly expanded opportunities for nurses through military service. Then, with the Great Depression, graduate nurses, who had been working privately in home care, were unemployed en masse. Mounting social pressure prompted hospitals to hire graduate nurses to provide patient care instead of relying exclusively on pupil nurses. In the midst of this upheaval, the 1934 Grading Committee Report forever altered the perception of nursing preparedness by identifying “collegiate education … as the preferred professional base” for nurses.21 Finally, the Servicemen's Readjustment Act of 1944, commonly called the G.I. Bill, pertained to nurses. At the end of World War II, 70,000 nurses became eligible for the G.I. Bill and could finally afford to go to college.21“Once there, nurses scurried to belong, to gain the credentials that legitimate an academic presence, to do research. For some nurses, research represented a means to the political end of respect and position in academe that would, it was hoped, carry over to other settings. To others, research yielded answers to questions that directed knowledge-based nursing practice in clinical, educational or administrative roles.21”Learning to do research became a major preoccupation among nurses seeking higher education. In addition to college courses making information available, professional associations and nursing journals gave workshops, sponsored conferences, and provided lists of research activities. In June 1952, the first issue of Nursing Research was published. But defining what constituted nursing research confounded everyone. Articles such as “Attitudes of Student Nurses at the University of California,”22 and “The Behavioral Sciences and Research in Nursing,”23 articles considering educational issues, and those describing nursing function all appeared under the broad category of “research.” The broad acceptance of almost any sort of problem solving as research exasperated nurses such as Virginia Henderson, who expressed her annoyance in a 1956 article entitled “Research in Nursing Practice—When?”24By the early 1960s, nursing began to find the answers to Henderson's query. With exceptional nursing leadership from Lucile Petry Leone, Margaret G. Arnstein, and Jessie M. Scott, the U.S. Public Health Service initiated the Faculty Research Development Grants (1959), the Nurse Scientist Graduate Research Training Grants (1962), and the Nurse Training Grants (1964). Because there were no nurse researchers with whom to study, under these grants nurse faculty members and doctoral students received research training from experts in biology, sociology, anthropology, microbiology, physiology, and psychology. Once exposed to expert research in other fields, nurses began to identify the critical elements of nursing that needed study. In other words, nursing theory was born.NURSING THEORY
In retrospect, it's obvious that theory was always inherent in nursing—in Nightingale's treatises on managing the environment in a caring and sanitary manner; Hobson's visits to ensure patient safety and her efforts to assemble a nursing corps to act on patients’ behalf; Hampton's endeavor to outline nursing actions in a uniform manner, incorporate science into those actions, and impose standards of care and reliability in all nursing programs; the zeal of Wald, Dock, and Goodrich for nursing reform, their inclusion of the broader community environment and the general public health in nursing actions, and their commitment to compassion as essential to nursing action. All these make up what we have come to know as the “metaparadigm of nursing,” which describes the interaction of person, environment, health, and nursing.25But nurses needed time and study to understand these new ways of expressing old ideas. A survey of nursing research literature from 1950 through 1974 found 111 theory articles, exceeded only by education (166 articles) and the research process (121 articles).26 As nurses grew more comfortable with the language of research and research methods, the number of “how to” articles in nursing literature declined, and actual research reports with outcomes began to be published. By the 1980s, more than half of the articles published in Nursing Research contained “fully developed, frequently funded, theory-grounded research articles.”21Hamilton has argued that the “nurse inventors needed an intellectual framework to guide their process of legitimizing nursing. To solidify the concept ‘nurse,’ to construct the phenomenon called ‘professional nursing,’ to fashion the boundaries of rightness and wrongness of nurse behavior, and to effectively negotiate acceptance of the validity of the trained nurse …”20 I would argue that the development of nursing theory in the late 20th century is equivalent to the 19th-century effort to professionalize nursing. The changing language, format, and customs of the times have shaped nursing in various ways, but the goals of nursing have remained the same: to ensure patient safety through the knowledge of caregivers and to reform sick care and nursing education, which are integral parts of the process.In any profession, expertise requires practitioners to rely on an amalgam of knowledge that is sufficiently dynamic to withstand changing times. As practice evolves, lawyers borrow from philosophers and ethicists, while physicians build medical practice on the expertise of physical and laboratory scientists. Similarly, nursing incorporates the physical, behavioral, and social sciences into its efforts to assist people dealing with actual and potential health problems in an ever-changing world.FINDINGS AND CONCLUSIONS
The professional status of nursing has been questioned over the years by people who see nurses as “nice people, mopping fevered brows.” My research into the first 100 years of American nursing provides a partial explanation for this misconception. Nursing was a 19th-century phenomenon, practiced primarily by women and affected by the restrictions and conditions that applied to women's activities until halfway through the 20th century.The G.I. Bill opened many educational doors for nurses, enabling them to expand their expertise and embrace behavioral, social, and biological sciences. Armed with the language and constructs of science, nurses began to ask questions, perform research, develop nursing theory, and apply research outcomes to nursing practice. Research has provided nurses with an intellectual framework to guide and explain their work, to answer questions about nursing's intellectual legitimacy, and, in the 21st century, to be recognized as the highly skilled experts they are.REFERENCES
1. Woolsey AHWoolsey AH. Hospitals and training schools A century of nursing; with hints toward the organization of a training school; and Florence Nightingale's historic letter on the Bellevue School, September 18, 1872. 1876/1950 New York G.P. Putnam's Sons
2. O'Brien P. ‘All a woman's life can bring’: the domestic roots of nursing in Philadelphia, 1830-1885 Nurs Res. 1987;36(1):12–7
3. Hampton IA Nursing of the sick, 1893, by Isabel A. Hampton and others. Papers and discussions from the International Congress of Charities, Correction and Philanthropy, Chicago, 1893, published in 1949 under the sponsorship of the National League of Nursing Education. 1949 New York McGraw-Hill
4. Hampton IA Nursing: its principles and practice. For hospital and private use. 1893 Philadelphia W.B. Saunders
5. Hobson EC Report of chairman of surgical wards for women, November 22, 1872. 1872 New York Frederick L. Ehrman Medical Library, NYU School of Medicine
6. Hofstadter R The age of reform: from Bryan to F.D.R. 1955 New York Alfred A. Knopf
7. Nightingale F Notes on nursing; what it is, and what it is not. 1859/1946 New York Appleton-Century
8. Nutting MA, Dock LL A history of nursing: the evolution of nursing systems from the earliest times to the foundation of the first English and American training schools for nurses. 1912;3 vols. New York G.P. Putnam's Sons
9. Lynaugh JED'Antonio P, et al. Work and knowledge: introduction Nurses’ work: issues across time and place. 2007 New York Springer Publishing Company:285–92
10. Reverby S Ordered to care: the dilemma of American nursing, 1850-1945. 1987 Cambridge, UK Cambridge University Press Cambridge history of medicine.
11. Richards L Reminiscences of Linda Richards, America's first trained nurse. 1911 Boston Whitcomb and Barrows
12. Kalisch PA, Kalisch BJ The advance of American nursing. 1978 Boston Little Brown and Company
13. James JWVogel MJ, Rosenberg CE. Isabel Hampton and the professionalization of nursing in the 1890s The therapeutic revolution: essays in the social history of American medicine. 1979 Philadelphia University of Pennsylvania Press:201–44
14. Billings JS, Hurd HM Hospitals, dispensaries and nursing. 1894 Baltimore, MD Hopkins Press
15. American Society of Superintendents of Training Schools for Nurses. First and second annual reports. 1897 Harrisburg, PA
16. Robb IH Suggestions on qualifications for future membership in the Society of American Superintendents. American Society of Superintendents of Training Schools for Nurses; 1898.
17. American Society of Superintendents of Training Schools for Nurses. Eighth annual convention. Harrisburg, PA; 1901.
18. Nutting MA. Memorial services for Isabel Hampton Robb, who died April 15, 1910 at Cleveland, Ohio Johns Hopkins hospital bulletin. 1910;21(Aug):6
19. Robb IH Nursing ethics: for hospital and private use. 1916 Cleveland, OH E.C. Koeckert
20. Hamilton D. Constructing the mind of nursing Nurs Hist Rev. 1994;2:3–28
21. Baer ED. ‘A cooperative venture’ in pursuit of professional status: a research journal for nursing Nurs Res. 1987;36(1):18–25
22. Ingmire AE. Attitudes of student nurses at the University of California Nurs Res. 1952;1(2):36–9
23. Sanford FH. The behavioral sciences and research in nursing Nurs Res. 1957;6(2):52–6
24. Henderson V. Research in nursing practice—when? Nurs Res. 1956;4(3):99
25. Fawcett J Contemporary nursing knowledge: analysis and evaluation of nursing models and theories. 20052nd ed. Philadelphia F.A. Davis Co.
26. Taylor SD. Bibliography on nursing research, 1950-1974 Nurs Res. 1975;24(3):207–25
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Key Ideas in Nursing's First Century
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