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The nursing theory began with the silent knowledge stage. Nurses were handicapped to be subservient and obedient and carry out their responsibilities to physicians without question. (Chinn & Kramer, 2011). Literature books and research data were limited, and nurses were not autonomous in their decision making, and only the skilled or expert nurse performed technical skills. Hospital schools believed it was unnecessary for nurses to acquire knowledge of theory and they were to only learn technical skills. There was little attempt to cultivate theory resulting in a restricted collection of data for the nursing metaparadigm. The lack of nursing education and training persisted for over 80 years. In 1924, Yale University started the first autonomous school of nursing and later other collegiate programs launched and professional educational teaching was strengthened to the underlying model of disease in addition to psychological, social, and physical aspects of a client welfare. As opposed to the medical model, which views mind and body separately and focuses on treatment and cure of pathological problems (McEwen and Wills, 2014, p. 29). In this stage, nurses were basically under physicians control no questions asked and no advancement.

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