Historical Perspective of Nursing Process

History and Evolution of the Nursing Process

The nursing process is a methodical approach that directs nurses in delivering patient-focused care. It is a structured framework that aims to provide a standardized and consistent approach to patient care. The historical perspective of nursing process traces back to the mid-20th century, evolving from the need to standardize nursing practice and improve patient outcomes. Here’s an overview:

Early Influences (19th Century)

Florence Nightingale’s influence on nursing cannot be overstated. During the Crimean War, Nightingale introduced systematic data collection and analysis to improve patient care. She emphasized the importance of sanitation, hygiene, and environmental factors in promoting health and preventing disease. Nightingale’s approach laid the groundwork for the systematic observation and assessment that are integral to the nursing process.

Formative Years (1950s-1960s)

In the mid-20th century, nursing theorists such as Ida Jean Orlando and Lydia Hall began to articulate frameworks that emphasized the systematic nature of nursing care. Orlando’s Nursing Process Theory emphasizes the importance of the nurse-patient relationship and the use of the nursing process to meet patient needs. Hall’s Conceptual Model of Nursing highlighted the dynamic interactions between the nurse, patient, and environment, shaping the early stages of the nursing process.

Standardization (1970s-1980s)

The 1970s and 1980s marked a period of standardization for nursing practice, largely driven by the American Nurses Association (ANA). The ANA’s publication of “Standards of Practice” in 1973 provided a framework for the systematic delivery of nursing care, incorporating elements of the nursing process. This standardization helped establish the nursing process as a fundamental component of nursing education and practice in the United States.

Refinement and Integration (1990s-Present)

Over the years, the nursing process has undergone refinement and integration into various healthcare settings. Nursing theorists such as Betty Neuman introduced holistic concepts that emphasized the interconnectedness of the patient’s physiological, psychological, and social dimensions. Dorothea Orem’s Self-Care Deficit Theory emphasized the importance of self-care and the role of the nurse in assisting patients to meet their own healthcare needs. These frameworks have contributed to the ongoing evolution of the nursing process.

Technology and Evidence-Based Practice

Advancements in technology and the adoption of evidence-based practice have transformed the application of the nursing process in contemporary healthcare settings. Electronic health records, clinical decision support systems, and other technological tools have streamlined data collection, assessment, and documentation processes. Nurses now rely on evidence-based guidelines and best practices to inform their decision-making throughout the nursing process.

Global Adoption

The nursing process has been embraced internationally as a framework for nursing practice, although its implementation may vary across different countries and cultures. In some regions, cultural factors may influence how the nursing process is applied. However, the core principles of assessment, planning, implementation, and evaluation remain universal, underscoring the global relevance of the nursing process in promoting high-quality patient care.

Overall, the historical perspective of nursing process reflects a gradual evolution from basic principles of patient care to a comprehensive framework that guides nursing practice in diverse healthcare settings. It underscores the importance of systematic assessment, planning, implementation, and evaluation to promote optimal patient outcomes and quality of care.

Key Contributors and Milestones in the Historical Perspective of Nursing Process

The nursing process evolved from numerous contributors and milestones into a systematic framework used in nursing practice. Here are some key contributors and milestones:

historical perspective of nursing process
  1. Florence Nightingale (1820-1910): Florence Nightingale, although not directly involved in formalizing the nursing process, played a crucial role in establishing the foundation of modern nursing practice through her pioneering work during the Crimean War. Her emphasis on observation, assessment, and environmental factors had a significant influence on the early development of systematic approaches to nursing care.
  2. Lydia Hall (1906-1969): Lydia Hall, a nurse and one of the great nursing theorists, played a crucial role in the evolution of the nursing process. Her “Core, Care, and Cure” framework conceptual model emphasized the dynamic interactions among the nurse, patient, and environment. Hall’s work was instrumental in highlighting the comprehensive and holistic nature of nursing care, and it helped shape the nursing process in its early stages.
  3. Ida Jean Orlando (1926-2007): Ida Jean Orlando is a renowned nurse and theorist who is known for her work on the nursing process and nursing theory. Her “Nursing Process Theory” emphasizes the significance of the nurse-patient relationship and the use of the nursing process to meet patient needs. Orlando’s theory laid the foundation for the methodical approach to nursing care embodied in the nursing process.
  1. American Nurses Association (ANA): The American Nurses Association (ANA) has played a crucial role in standardizing nursing practice and promoting the adoption of the nursing process. In 1973, the ANA published the first edition of “Standards of Practice,” which included the key elements of the nursing process. This publication helped establish the nursing process as a fundamental framework for nursing care in the United States.
  2. Betty Neuman (1924-2019): Betty Neuman was a nurse and theorist who gained recognition for her work on the “Neuman Systems Model.” Her model focused on holistic care and emphasized the interdependence between the patient’s physiological, psychological, and social dimensions. Neuman’s contributions to the nursing process refined and integrated it by stressing the significance of considering the patient within their environmental context.
  3. Dorothea Orem (1914-2007): Dorothea Orem was a nurse and theorist who is renowned for developing the “Self-Care Deficit Theory.” This theory emphasizes the role of nurses in helping patients to fulfill their healthcare requirements. Orem’s theory offers a structure for comprehending the nursing process as a collaborative effort between the patient and the nurse to enhance self-care and wellness.
  4. Integration of Evidence-Based Practice: The integration of evidence-based practice (EBP) into nursing education and practice has further shaped the development of the nursing process. EBP emphasizes the use of the best available evidence, clinical expertise, and patient preferences to guide nursing practice. The incorporation of EBP principles into the nursing process ensures that nursing care is based on the latest research and best practices.

Overall, these key contributors and milestones have played a significant role in shaping the development and evolution of the nursing process into the systematic framework used by nurses to deliver high-quality, patient-centered care.

Challenges and Criticisms of the Nursing Process in Early Times

In its early stages of development, the nursing process faced challenges and criticisms that reflected the evolving understanding of nursing practice and healthcare delivery. Here are some of the challenges and criticisms during those times:

  • Resistance from Traditional Medical Models: During the early development of nursing, the medical profession held significant authority within healthcare settings. Physicians were often considered the primary decision-makers, and nursing was viewed as a subordinate role focused on carrying out physician orders. This hierarchical structure sometimes led to resistance from medical professionals to nursing frameworks that emphasized independent decision-making and intervention by nurses. The introduction of systematic approaches like the nursing process may have challenged traditional power dynamics within healthcare institutions, leading to skepticism or pushback from physicians and other healthcare providers.
  • Limited Recognition of Nursing as a Profession: Nursing initially lacked recognition as a distinct profession with its own body of knowledge and standards of practice. Instead, it was often perceived as an extension of domestic or caregiving duties traditionally associated with women. This lack of professional recognition could have hindered the adoption of systematic frameworks like the nursing process, as nurses may have struggled to assert their autonomy and expertise within healthcare settings.
  • Lack of Formal Education and Training: In the early days of nursing, formal education and training programs were scarce. Many nurses learned their skills through apprenticeship or on-the-job training, which may have resulted in variability in practice and a lack of consistency in applying frameworks like the nursing process. Without standardized education and training programs, nurses may have had limited exposure to systematic approaches to patient care and may have relied more heavily on traditional methods and practices.
  • Focus on Task-Oriented Care: Healthcare delivery in early times often prioritized completing tasks and following physician orders over holistic patient care. Nurses may have been expected to focus on carrying out specific tasks rather than engaging in comprehensive assessment and care planning. This task-oriented approach could have detracted from the implementation of the nursing process, which emphasizes systematic assessment, planning, intervention, and evaluation to address the holistic needs of patients.
  • Inadequate Resources and Support: Nursing practice in early times was characterized by limited resources, including staffing, equipment, and educational opportunities. Nurses may have lacked the support and infrastructure needed to fully implement systematic approaches like the nursing process in their daily practice. Without adequate resources, nurses may have struggled to conduct thorough assessments, develop comprehensive care plans, and provide the level of care envisioned by frameworks like the nursing process.
  • Gender Bias and Stereotypes: Nursing has long been associated with femininity and gender bias and stereotypes may have influenced perceptions of nursing practice. Nursing was often seen as an extension of women’s caregiving roles within the family, which could have undermined efforts to establish nursing as a distinct profession with its own specialized knowledge and skills. Gender bias may have also contributed to the devaluation of nursing work and hindered efforts to promote nursing frameworks like the nursing process as essential components of healthcare delivery.
  • Resistance to Change within the Nursing Community: Even within the nursing community, there may have been resistance to adopting new frameworks and approaches to practice. Nurses who were accustomed to traditional ways of delivering care may have been hesitant to embrace systematic models like the nursing process, particularly if they perceived them as overly bureaucratic or rigid. Resistance to change within the nursing community could have slowed the integration of the nursing process into nursing practice and hindered efforts to advance the profession.

Despite these challenges and criticisms, the nursing process gradually gained acceptance and recognition as a valuable framework for organizing and delivering nursing care. Over time, efforts to standardize nursing education, promote professional autonomy, and improve healthcare delivery have contributed to the integration of the nursing process into nursing practice.


The nursing process has a rich historical background and is a cornerstone of nursing practice. Its development can be traced back to influential nursing theorists. Over the years, the nursing process has evolved and been refined to meet the changing needs of healthcare. It serves as a systematic approach to patient care, providing a framework for assessment, diagnosis, planning, implementation, and evaluation.

The nursing process is essential for clinical reasoning, promoting evidence-based practice, and ensuring high-quality, patient-centered care. As healthcare continues to advance, the nursing process will continue to evolve, embracing technology and innovation to improve patient outcomes. The enduring significance of the nursing process lies in its ability to provide a structured and comprehensive approach to nursing care, ultimately benefiting both patients and healthcare providers.


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