Author/Source
Metaparadigm Concept of Definition Definition
B. Neuman All internal and external factors of influences that surround the client or client system.
M. Rogers An irreducible, pandimensional energy field identified by pattern and integral with the human field.
C. Roy All conditions, circumstances, and influences that surround and affect the development and behavior of human adaptive systems with particular consideration of person and earth resources.
Sources: Johnson (1980); Leininger (1991); Neuman (1995); Newman (1990); Orem (2001); Rogers (1990); Roy and Andrews (1999); Watson (1985).
process denotes the greatest difference between this framework and the more com- monly described person/health/environment/nursing framework.
Thus, it is argued by Fawcett and Maliniski (1996) that although caring is included in several conceptualizations of the discipline of nursing, it is not a dominant term in every conceptualization and therefore does not represent a discipline-wide viewpoint. Furthermore caring is not uniquely a nursing phenomenon, and caring be- haviors may not be generalizable across national and cultural boundaries.
Summary
Like Matt Ng, the graduate nursing student described in the opening case study, nurses who are in a position to learn more about theory, and to recognize how and when to apply it, must often be convinced of the relevance of such study and to understand the benefits. The study of theory requires exposure to many new concepts, principles, thoughts, and ideas, as well as a student who is willing to see how theory plays an important role in nursing practice, research, education, and administration.
Although study and use of theoretical concepts in nursing dates back to Nightin- gale, little progress in theory development was made until the 1960s. Indeed, the past five decades have produced significant advancement in theory development for nurs- ing. This chapter has presented an overview of this evolutionary process. In addition, the basic types of theory and purposes of theory were described. Subsequent chapters will explain many of the concepts introduced here to assist advanced practice nurses to understand the relationship among theory, practice, and research and to further de- velop the discipline, the science, and the profession of nursing.
LEARNING ACTIVITIES
1. Examine early issues ofNursing Research(1950s and 1960s) and determine whether theories or theoretical frameworks were used as a basis for research. What types of theories were used? Review current issues to analyze how this has changed.
2. Examine early issues of American Journal of Nursing(1900–1950). Determine if and how theories were used in nursing practice. What types of theories were used? Review current issues to analyze how this has changed.
3. Find reports that present middle range or practice theories in the nursing literature.
Identify if these theories are descriptive, explanatory, predictive, or prescriptive in nature.
4. With classmates, debate whether caring should or should not be part of the nurs- ing metaparadigm.
INTERNET RESOURCES
The Hahn School of Nursing Theory Page—contains links to sites for information on many grand and middle range nursing theories.
http://www.sandiego.edu/academics/nursing/theory/
Nurse Scribe’s Nursing Theory Page—contains links to many grand nursing theorists’ home pages as well as links to other reference materials related to nursing theory.
http://www.enursescribe.com/nurse_theorists.htm
Clayton College Department of Nursing’s Nursing Theory Link Page—contains comprehen- sive links to sites containing information for grand and middle range nursing theories.
http://healthsci.clayton.edu/eichelberger/nursing.htm
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46
C H A P T E R
Concept Development: Clarifying Meaning of Terms
3
E v e l y n W i l l s a n d M e l a n i e M c E w e n
M
ary Talbot is a home health nurse with several years of experience. Recently Mary was assigned to care for Mrs. Janet Benson, who had had a mastectomy.The pathology report revealed a slow-growing, noninvasive carcinoma in situ;
there were no involved nodes, and further tests showed no metastasis. Mrs. Benson was thankful that she was most likely free of the disease.
In the hospital, Mrs. Benson progressed well. But after she was discharged and began chemotherapy, she would frequently weep over things that seemed trivial. Her husband called Mary because he was concerned as this was not Mrs. Benson’s usual behavior. Typically, she was self-contained, stoic, and accepting of life’s circumstances, seldom demonstrating excessive emotion. To try to better understand Mrs. Benson’s response, and to plan care accordingly, Mary consulted Rebecca Wallis, a certified oncology nurse specialist (ONS). After discussing the case with Mary, Rebecca set up an appointment with the Bensons. To gather data from both Mr. and Mrs. Benson’s viewpoints, Rebecca asked each of them to explain how they felt about Mrs. Benson’s cancer. Mr. Benson replied that the loss of his wife’s breast was a small matter to him; he loved her for herself, and he was grateful that she was getting well.
Mrs. Benson seemed relieved by his pronouncement. In response to Rebecca’s
questioning, she focused on her sadness and inquired if this was common in women who had had a mastectomy. Rebecca explained that the reaction was quite common and that oncology nurses in the region used the term postmastectomy grief (PMG) reaction to describe it. The ONSs had worked out a protocol of nursing therapy for PMG, but it had not been formally tested. In the protocol they requested that the physician oncologist refer the patient to a psychiatric home health nurse for an assessment. The psychiatric home health nurse would confer with the oncologist and the nurse practitioner and, if needed, would request a referral to a licensed therapist. Additionally, a group called “Breast Cancer Support” had been organized in the area by women who had undergone a mastectomy. In this group, problems such as sadness were discussed by women who had experienced them, and support given to those who were going through recovery from breast cancer surgery.
Rebecca recommended that the Bensons attend a meeting.
Experienced nurses, although focused on the practical application of nursing knowl- edge, demonstrate an inclination toward generalizing what they have learned from a group of clients to other clients with similar problems. This is obvious in the profes- sional discussions of clinical nurses, particularly those educated for advanced practice, who might state, “we see certain phenomenon frequently enough in practice that we have developed clinical protocols or interventions.”
These observed phenomena are considered by nurses to be reliable, enduring, and stable features of practical experience, whether or not they have acquired a name and whether or not they have been studied in research (Kim, 2000, 2006). Expert practice and enhanced education lead advanced practice nurses to recognize commonalities in phenomena that suggest the need for inquiry. This, in turn, may guide development of clinical hypotheses and testing of interventions (Cutcliffe & Mckenna, 2005; Wilson &
Raines, 1999). With the current focus on evidence-based practice, clear delineation of the concepts under study in research requires that the linkages among phenomena, concepts, and practice be clarified (Hupcey & Penrod, 2008).
For the nurse who desires to discriminately, formally, and concretely examine a phenomenon in depth, such as described above, the most logical place to start is by defining the phenomenon or concept for further study. This is not an easy task, however, and significant time, research, and effort must be made to adequately define nursing concepts (Duncan, Cloutier, & Baily, 2007; Kim, 2006). To simplify the pro- cess, a number of strategies and methods for concept analysis, concept development, and concept clarification have been proposed and used by nursing scholars for many years.
The rationale for concept development and several methods commonly used by nurses are discussed in this chapter. This will allow advanced practice nurses to develop or clarify meanings for the phenomena encountered in practice. The outcome can then serve as the basis for further development of theory for research and practice.
The Concept of “Concept”
Concepts are terms that refer to phenomena that occur in nature or in thought. Concept has been defined as an abstract term derived from particular attributes (Kerlinger, 1986) and “a symbolic statement describing a phenomenon or a class of phenomena” (Kim, 2000, p. 15). Concepts may be abstract (e.g., hope, love, desire) or relatively concrete (e.g., airplane, body temperature, pain). Concepts are formulated in words that en- able people to communicate their meanings about realities in the world (Cutcliff &
McKenna, 2005; Kim, 2000; Parse, 1999; Penrod & Hupcey, 2005) and give mean- ing to phenomena that can directly or indirectly be seen, heard, tasted, smelled, or touched (Fawcett, 1999). A concept may be a word (e.g., grief, empathy, power, pain), two words (e.g., job satisfaction, need fulfilment, role strain), or a phrase Mrs. Benson’s case, and the problem of PMG reaction in general, prompted Rebecca
to seek more information about this reaction of breast cancer patients. Her review of the literature suggested that the phenomena needed further study to develop the knowledge base for practice. Because of her education, she realized that she first needed to define and name the problem. To this end, she chose to use concept development strategies she had learned in her graduate nursing program to initiate preparation for a formal research study.
TABLE 3-1Types of Concepts
(e.g., maternal role attachment, biomarkers of preterm labor, health-promoting be- haviors). Finally, when they are operationalized, concepts become variables used in hypotheses to be tested in research.
Concepts have been compared to bricks in a wall that lend structure to science (Hardy, 1973). Chinn and Kramer (2008) believe that concepts are more than terms, and constructing conceptual meaning is a vital approach to theory building in which mental constructions or ideas are used to represent experiences. Similarly, Parse (2006) agrees that formal study of concepts enhances knowledge development for nursing through naming, creating, and confirming the phenomena of interest.
Although it was once thought that concepts could be defined once and for all, that idea has been disputed (Penrod & Hupcey, 2005; Rodgers & Knafl, 2000). Theorists now understand that conceptual meaning is created by scholars to assist in imparting the meaning to their readers and, ultimately, to benefit the discipline. Conceptual fluidity and dependence on the context is common in writings on concept analysis in current literature (Duncan, Cloutier, & Bailey, 2007; Penrod & Hupcey, 2005). This makes it imperative that scholars and researchers define concepts clearly and distinctly so that their readers may thoroughly and accurately comprehend their work. Because concep- tual meanings are dynamic, they should be defined for each specific use the writer or researcher makes of the term. Indeed, concepts are defined and their meanings are under- stood only within the framework of the theory of which they are a part (Hardy, 1973).