Several different approaches may be used to initiate the process of theory develop- ment. Meleis (2007) cites four major strategies differentiated by their origin (theory, practice, or research) and by whether sources from outside of nursing were used to develop the theory. These approaches are theory–practice–theory, practice–theory, research–theory, and theory–research–theory. She then proposes employment of an integrated approach to theory development. Table 4-3 summarizes these different approaches.
Theory–Practice–Theory
The theory–practice–theory approach to theory development begins with a theory (typically nonnursing) that describes a phenomenon of interest. This approach as- sumes that the theory can help describe or explain the phenomenon, but it is not completely congruent with nursing and is not directly defined for nursing practice;
the focus of the theory is different from the focus needed for nursing.
Using the theory–practice–theory strategy, the nurse would select a theory that may be used to explain or describe a clinical situation (e.g., adaptation, stress, health beliefs). The nurse could modify concepts and consider relationships between con- cepts that were not proposed in the original theory. To accomplish this, the nurse would need to (1) have a basic knowledge of the theory; (2) analyze the theory by re- ducing it into components where each component is defined and evaluated; (3) use assumptions, concepts, and propositions to describe the clinical area; (4) redefine as- sumptions, concepts, and propositions to reflect nursing; and (5) reconstruct a theory using exemplars representing the redefined assumptions, concepts, and propositions (Meleis, 2007). Examples of a theory–practice–theory strategy include Benner’s use of Dreyfus’s Model of Skill Acquisition to describe novice to expert practice (Benner, 2001) and Roy’s use of Helson’s Adaptation Theory to describe human responses
(Roy & Roberts, 1981). Other examples of theory–practice–theory in recent nursing literature include a work that applied the Theory of Planned Behavior to develop a situation-specific theory of breastfeeding (Nelson, 2006) and Peters’ (2006) theory of chronic stress emotions, which was derived from Lazarus’s theory of stress using a descriptive, correlational design.
Practice–Theory
If no appropriate theory appears to exist to describe or explain a phenomenon, theo- ries may be inductively developed from clinical practice situations. The practice–theory approach is based on the premise that in a given situation existing theories are not use- ful in describing the phenomenon of interest. It assumes that the phenomenon is important enough to pursue and that there is a clinical understanding about it that has not been articulated. Furthermore, insight gained from describing the phenomenon has potential for enhancing the understanding of other similar situations through de- velopment of a set of propositions (Meleis, 2007).
Origin of Theory Basis for Development Type of Theory Methods for Development Theory–practice–
theory An existing theory
(nonnursing) that can help describe and explain a phenomenon, but the theory is not complete or not completely developed for nursing
Borrowed or shared
theory Theorist selects a nonnursing theory; analyzes the theory;
defines and evaluates each component; redefines assumptions, concepts, and propositions to reflect nursing Practice–theory Existing theories are not
useful in describing the phenomenon of interest;
theory is derived from clinical situations
Grounded theory Researcher observes phenomenon of interest, analyzes similarities and differences, compares and contrasts responses, and develops concepts and linkages
Research–theory Development of theory is based on research; theories evolve from replicated and confirmed research findings
Scientific theory Researcher selects a common phenomenon, lists and measures characteristics of the phenomenon in a variety of situations, analyzes the data to determine if there are patterns that need further study, and formalizes patterns as theoretical statements Theory–research–
theory Theory drives the research
questions; the result of the research informs and modifies the theory
Theory testing Theorist defines a theory and determines propositions for testing; the theory is modified, refined, or further developed based on research findings; in some cases a new theory will be formed
TABLE 4-3Strategies for Theory Development
Source: Meleis (2007).
This strategy is a grounded theory approach, which begins with a question evolv- ing from a practice situation. It relies on observation of new phenomena in a practice situation, development of concepts, and then labeling, describing, and articulating properties of these concepts. To accomplish this, the researcher observes the phe- nomenon, analyzes similarities and differences, and then compares and contrasts responses. Following this, the researcher may develop concepts and propositional statements and propose linkages (Meleis, 2007). Examples of the practice–theory strat- egy of theory development include a situation-specific theory of Caucasian cancer pa- tients’ pain experience (Im, 2006), and a proposed theory of “keeping the spirit alive”
among children with cancer and their families (Woodgate & Degner, 2003).
Research–Theory
The research–theory strategy is the most accepted strategy for theory development in nursing, largely due to the early emphasis on empiricism described in Chapter 1. For empiricists, theory development is considered a product of research because theories evolve from replicated and confirmed research findings. The research–theory strategy assumes that there is truth in real life, that the truth can be captured through the senses, and that the truth can be verified (Meleis, 2007). Furthermore, the purpose of scien- tific theories is to describe, explain, predict, or control a part of the empirical world.
In the research–theory strategy for theory development, the researcher selects a phenomenon that occurs in the discipline and lists characteristics of the phe- nomenon. A method to measure the characteristics of the phenomenon is developed and implemented in a controlled study. The results of the measurement are analyzed to determine if there are any systematic patterns, and once patterns have been discov- ered, they are formalized into theoretical statements (Meleis, 2007). Examples of the research–theory strategy from nursing include the development of a taxonomy of passive behaviors in people with Alzheimer’s disease (Colling, 2000), a report out- lining a conceptual framework for caring in nursing practice (McCance, 2003), and a theoretical look at the involvement of relatives in palliative care (Andershed &
Ternestedt, 2001).
Theory–Research–Theory
In the theory–research–theory approach, theory drives the research questions and the results of the research are used to modify the theory. In this approach, the theorist will begin by defining a theory and determining propositions for testing. If carried through, the research findings may be used to further modify and develop the original theory (Meleis, 2007).
In this process, a theory is selected to explain the phenomenon of interest. The the- ory is a framework for operational definitions, variables, and statements. Concepts are redefined and operationalized for research. Findings are synthesized and used to mod- ify, refine, or develop the original theory, or in some cases, to create a new theory. The goal is to test, refine, and develop theory and to use theory as a framework for research and theory modification. The researcher/theorist concludes the investigation with a refined, modified, or further developed explanation of the theory (Meleis, 2007). Ex- amples of the theory–research–theory approach from recent nursing literature include a theory of genetic vulnerability developed from Roy’s Adaptation Model using grounded theory methodology (Hamilton & Bowers, 2007), and Dunn’s (2004, 2005) middle range theory of adaptation to chronic pain, which was also derived from Roy’s Adaptation Model. Another example includes the theory of diversity of human field pattern, which was developed from Martha Rogers’ Science of Unitary Human Beings using a quantitative research design (Hastings-Tolsma, 2006).
Integrated Approach
An integrated approach to theory development describes an evolutionary process that is particularly useful in addressing complex clinical situations. It requires gathering of data from the clinical setting, identification of exemplars, discovery of solutions, and recognition of supportive information from other sources (Meleis, 2007).
Integrated theory development is rooted in clinical practice. Practice drives the basic questions and provides opportunities for clinical involvement in research that is designed to answer the questions. In this process for theory development, hunches and conceptual ideas are communicated with other clinicians or participants to allow for critique and further development. Among other strategies, the integrated ap- proach uses skills and tools from clinical practice, various research methods, clinical diaries, descriptive journals, and collegial dialogues in developing a framework or con- ceptualization (Meleis, 2007).