As discussed in Chapter 2, Dickoff and James (1968) described four kinds of theory:
factor-isolating theories (descriptive theories), factor-relating theories (explanatory theories), situation-relating theories (predictive theories), and situation-producing theories (prescriptive theories). Each higher level of theory builds on the lower levels (Dickoff et al., 1968), and each is reviewed in the following sections.
Descriptive Theories
Descriptive theories describe, observe, and name concepts, properties, and dimen- sions, but they do not explain the interrelationships among the concepts or proposi- tions, and they do not indicate how changes in one concept affect other concepts.
According to Barnum (1998), descriptive theory is the first and most important level of theory development because it determines what will be perceived as the essence of the phenomenon under study. Subsequent theory development expands or refines those elements and specifies relationships that are determined to be important in the
Clarifies Guides Directs
Provides material for Refines
Tests in Practice
FIGURE 4-1Relationship among levels of theory. (From Walker, L. O., & Avant, K. C. (2005). Strategies for theory construction in nursing(4th ed.). Upper Saddle River, NJ: Prentice-Hall.
Reprinted by permission of Pearson Education, Inc., Upper Saddle River, NJ.)
descriptive phase. Thus, it is critical that the most significant constituents of the phe- nomenon be recognized and named in this earliest phase of theory development.
The two types of descriptive theory are naming and classification. Naming theories describe the dimension or characteristics of a phenomenon. Classification theoriesde- scribe dimensions or characteristics of a phenomenon that are structurally interrelated and are sometimes referred to as typologies or taxonomies (Barnum, 1998; Fawcett, 1999).
Descriptive theories are generated and tested by descriptive or explanatory research.
Techniques for generating and testing descriptive theory include concept analysis, case studies, comprehensive literature review, surveys, phenomenology, ethnography, grounded theory, and historical inquiry (Fawcett, 1999). Examples of descriptive theory found in recent nursing literature include the development of a model for the HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets) in pregnant women (phenomenology) (Kidner & Flanders-Stepans, 2004); development of a model for un- derstanding caregiving changes among poor, chronically ill Mexicans (ethnography) (Robles-Silva, 2008); and the proposed middle range Theory for Generative Quality of Life for the Elderly (comprehensive literature review) (Register & Herman, 2006). In other examples, Zauderer (2008) used a case study approach to examine the phe- nomenon of altered maternal–newborn attachment and Rew (2003) used grounded theory to explore self-care behaviors of homeless youth.
Explanatory Theories
Explanatory theory is the second level in theory development. Once phenomena have been identified and named, they can be viewed in relation to other phenomena.
Explanatory theories relate concepts to one another and describe and specify some of the associations or interrelations between and among the concepts. Further, explana- tory theories attempt to tell how or why the concepts are related and may deal with causality, correlations, and rules that regulate interactions (Barnum, 1998; Dickoff et al., 1968).
Explanatory theories can be developed only after the parts of the phenomena have been identified and tested, and they are generated and tested by correlational re- search. Correlational research requires collection or measurement of data gathered by observation or self-report instruments that will yield either qualitative or quantitative data (Fawcett, 1999). Examples of explanatory theories from recent nursing literature include development of a theory of diversity of human field pattern (Hastings- Tolsma, 2006); an examination of resilience among operating room nurses (Gillespie, Chaboyer, Wallis, & Grimbeek, 2007); and a practice theory identifying the cues that trigger participation in prostate screening (Nivens, Herman, Weinrich, & Weinrich, 2001). In a qualitative study, Olshansky (2003) developed a theoretical model through combining previously described constructs of “identity as infertile” and “vul- nerability to depression.” Similarly, Moore and Coty (2006) developed a model of breastfeeding behavior involving such constructs as breastfeeding attitude, support for breastfeeding, breastfeeding behavioral control, and barriers and problems en- countered with breastfeeding.
Predictive Theories
Predictive theories describe precise relationships between concepts and are the third level of theory development. Predictive theories presuppose the prior existence of the more elementary types of theory. They result after concepts are defined and relational state- ments are generated and are able to describe future outcomes consistently. Predictive theories include statements of causal or consequential relatedness (Dickoff et al., 1968).
Predictive theories are generated and tested by experimental research involving ma- nipulation of a phenomenon to determine how it affects or changes some dimension or characteristic of another phenomenon (Fawcett, 1999). Different research designs may be used in this process. These include pretest–posttest designs, quasi-experiments, and true experiments. These research studies produce quantifiable data that are statistically analyzed. Examples of predictive theories include a model examining patient satisfaction with nurse practitioner care (Green & Davis, 2005), a model identifying social cognitive factors that predict elders’ health (Zauszniewski, Chung, & Krafcik, 2001), and a model predicting physical activity in older adults with hypertension (Lee & Laffrey, 2006). In an interesting work, Tourangeau (2005) synthesized research literature from multiple sources to propose a theoretical model predicting patient mortality. She identified the following contributing or determining factors to mortality: nurses’ staffing, burnout, satisfaction, skill mix, experience and role support, as well as such factors as physician expertise, hospital location, and patient characteristics (e.g., age, gender, comorbidity, socioeconomic status, and chronicity).
Prescriptive Theories
Prescriptive theories are perceived to be the highest level of theory development (Dickoff et al., 1968). Prescriptive theories prescribe activities necessary to reach de- fined goals. In nursing, prescriptive theories address nursing therapeutics and predict the consequence of interventions (Meleis, 2007). Prescriptive theories have three basic components: (1) specified goals or outcomes, (2) explicit activities to be taken to meet the goal, and (3) a survey list that articulates the conceptual basis of the theory (Dickoff et al., 1968).
According to Dickoff et al. (1968), the outcome or goal of a prescriptive theory serves as the norm or standard by which to evaluate activities. The goal must articu- late the context of the situation, and this provides the basis for testing to determine whether the goal has been achieved. The specified actions or activities are those nurs- ing interventions that should be taken to realize the goal. The goal will not be real- ized without the activity, and prescriptions for activities directly affect the goals.
The survey list augments and supplements the prescribed activities. In addition, it serves to prepare for future prescriptive activities. The survey list asks six questions about the prescribed activity that relate to the delineated goal (Box 4-1).
Examples of prescriptive theory are becoming more common in the literature, en- hanced by the expanding volume of nursing research and increasing calls for evidence- based practice. The descriptions of feeding, pelvic floor exercise, therapeutic touch, and latex precautions are only a few of many excellent examples of nursing interventions
1. Who performs the activity? (agency)
2. Who or what is the recipient of the activity? (patiency) 3. In what context is the activity performed? (framework) 4. What is the end point of the activity? (terminus)
5. What is the guiding procedure, technique, or protocol of the activity? (procedure)
6. What is the energy source for the activity? (dynamics) Source: Dickoff et al. (1968).
BOX 4-1
Survey List of Questions for Prescriptive
Theories
presented by Bulechek, Butcher, & Dochterman (2008). Lefort’s (2000) model to assist self-help in adults with chronic pain is another example.