COMPARISON OF MODELS FOR CONCEPT DEVELOPMENT

The nursing literature contains several comparisons and critiques of the various models and methods for concept development/concept analysis. Indeed, Hupcey and colleagues (1996) and Morse and coworkers (1996) provided a detailed and well-researched

Epistemological principleis based on the question: “Is the concept clearly defined and well differentiated from other concepts?” (p. 405).

Pragmatic principlein which the question to be answered is: “Is the concept applica- ble and useful within the scientific realm or inquiry? Has it been operationalized?”

In this principle, they believe that an operationalized concept has achieved a level of maturity (p. 405).

Linguistic principleasks “Is the concept used consistently and appropriately within

context?” (p. 406). Similarly to Morse and to Rogers, they find that context or lack of context is a factor important in this type of analysis (p. 406).

Logical principleapplies the question:

“Does the concept hold its boundaries through theoretical integration with other concepts?” (p. 406). The authors require that the concept not be blurred with respect to other concepts, but that it remains logically clear and distinct.

Source: From Penrod and Hupcey (2005, pp. 405–406).

BOX 3-5

Four Principles of Concept Analysis

Number Constructed

Author(s) Method Purpose of Steps Cases Other Factors/Steps

Walker Concept Clarify meaning 8 Model, borderline, Identify empirical

and Avant analysis of terms related, contrary referents and

defining attributes;

delineate antecedents and consequences Rodgers Evolutionary Refine and clarify 5 Model only Identify appropriate

concept concepts for use in (Identified— realm (setting and

analysis research and not constructed) sample); analyze data

practice about characteristics,

. conduct interdisciplinary

or temporal comparisons;

identify hypotheses and implications for further study

Swartz- Hybrid model Support or refine 3 phases Model case, Develop working

Barcott of concept the meaning of contrary case definitions, search

and Kim development a concept and/or literature, participant

develop a new or observation, collect

refined way to and analyze data, write

measure a concept findings

Meleis Concept Define concepts 7 Same or like Define concept,

development theoretically and models; use an analogy to

operationally, clarify contrary describe a similar

ambiguities, relate models concept, synthesize

concepts to findings; differentiate

empirical referents similarities and

differences between like concepts; delineate antecedents and consequences

Morse Concept Clarifies the 3 phases Not specified Uses extensive

comparison meaning of literature review to

competing examine and describe

concepts preconditions (status of

use of the concepts in teaching or practice), process, and outcomes of use of the concept

Penrod Principle- Concept 4 phases Not specified Sampling within

and Hupcey based analysis based on bodies of large

concept principles multidisciplinary

analysis literature yields a

theoretically based scientific definition

comparison of the techniques presented by Walker and Avant (1986), Swartz-Barcott and Kim (1993), and Rodgers (1989). Strengths and weaknesses of each method were described in their papers. More recently Duncan, Cloutier, and Bailey (2007) reviewed the history of concept analysis comparing the major methods in common use.

TABLE 3-9Comparison of Selected Methods of Concept Development

A number of works comparing two different methods of concept analysis were found in the literature. For example, Fu, LeMone, and McDaniel (2004) used an in- tegrative approach combining the methods of Walker and Avant and Rodgers to analyze symptom management. Penrod (2007) advanced the concept of living with uncertainty using the methods espoused by Morse and Penrod and Hupcey, and Shin and White-Traut (2007) analyzed the concept of transition to motherhood in the neonatal intensive care unit combining elements from Rogers’ evolutionary method and Swartz-Barcott and Kim’s Hybrid Model. Table 3-9 on page 63 compares the various formats for concept development/concept analysis described earlier.

Summary

Rebecca Wallis, one of the nurses from the opening case study, identified what she thought was a new phenomenon that was pertinent to her practice of oncology nursing and decided to develop the concept more fully. By applying techniques of concept analysis to the PMG reaction, she began the process of formulating information on this concept that could ultimately be used by other nurses in practice or research.

The process of developing concepts includes reviewing the nurse’s area of interest, examining the phenomena closely, pondering the terms that are relevant and that fit together with reality, and operationalizing the concept for practice, research, or edu- cational use. Whether advanced practice nurses or nursing scholars elect to use the methods proposed by Wilson (1963), Walker and Avant (1986, 1995, 2005), Morse (1995), Rodgers (2000), Swartz-Barcott and Kim (2000), Meleis (2007), or Penrod and Hupcey (2005), or a combination, it is clear that the process of developing, clar- ifying, comparing and contrasting, and integrating well-derived and defined concepts is necessary for theory development and to guide research studies. This will, in turn, ultimately benefit practice. Chapter 4 builds on the process of concept development by describing the processes used to link concepts to form relationship statements and to construct conceptual models, frameworks, and theories.

C

ONCEPT ANALYSIS EXEMPLAR

The following is an outline delineating the steps of a concept analysis using Rodgers’ evolutionary method.

Breen, J. (2002). Transitions in the concept of chronic pain. Advances in Nursing Science, 24 (4), 48–59.

1. Identify the concept and associated terms Concept: Chronic pain (noncancerous pain in adults)

Associated terms: Chronic pain, persistent pain, intractable pain, and continuous pain 2. Select an appropriate realm (setting) for data collection

The realm for the study was nursing, psychology, and neurophysiology professional journal publications between the years 1969 and 1999. Included were case studies, qualitative and quantitative studies, review articles, and meta-analyses.

3. Identify the attributes of the concept and the contextual basis of the concept

Attributes of chronic pain: Their primary dimensions (physical, behavioral, and psychological) Physical dimension is characterized by quantity, intensity (level or severity), neurological transmission,

and anatomic patterns of chronic pain.

Behavioral dimension is characterized by expressive, movement, and functional behaviors.

Psychological dimension is characterized by affective and evaluative components.

4. Specify the characteristics of the concept Characteristics of chronic pain include:

Relative language (e.g., “ache”) and modifiers (e.g., “annoying” or “dull”).

Behaviors: Expressive behaviors (moaning and use of pain words); movement behaviors (grimacing, mas- saging, protective movements, rhythmic movements); functional behaviors (use of socially defined sick-role behaviors such as decreased mobility, inactivity, and bed rest).

Time dimension: Include onset and frequency or rhythm of pain episodes.

Antecedents: No specific physical or psychological characteristics were noted that were antecedents of chronic pain. Although trauma sometimes precedes chronic pain, trauma is not necessary or sufficient to cause chronic pain. Chronic pain may be related to alterations in the production and regulation of cortisol, serotonin, and endogenous opioids and in the synthesis and release of sensory neuropeptides.

Consequences: Two themes: living with chronic pain results in alterations of psychological life patterns including depression, anger, anxiety, grief, hopelessness, and helplessness; social pattern alterations may result in isolation and loneliness; there may be loss of work, and consequently, loss of insurance and money to pay for medical expenses; and coping with chronic pain—effective coping—decreases the adverse effects of chronic pain by reducing stress and thereby reducing pain intensity. Strategies include distraction, meditation, positive thinking, counseling, and use of alternative treatments (e.g., acupuncture, massage, herbal medications, meditation, and imagery).

5. Identify an exemplar of the concept

Chronic pain is a subjective, multidimensional, bio/psycho/social syndrome that can be recognized by physical, psychological, and behavioral patterns. Chronic pain results in physical, psychological, and social alterations of function to varying degrees. There is no known purpose and there is no single explanation of the symptoms.

6. Identify hypotheses and implications for development

Research is needed to understand the relationship between intensity, quality and duration of pain, and central nervous system function.

Research is needed to explore body–brain–mind interactions in the development, persistence, and consequences of chronic pain.

Research is needed to identify the subjective symptoms that may differentiate chronic pain from acute pain. If early symptoms can be identified, studies can be conducted to determine interventions that may stop the development of chronic pain.

LEARNING ACTIVITIES

1. From a literature search or clinical practice, choose a term or concept of interest.

Review the literature for discussion of the concept. Discriminate between the concept of interest and associated terms and write a scholarly paper that defines and develops the concept.

2. Obtain a copy of Walker and Avant’s (2005), or Rodgers’ (2000) work that pre- sents methods for analyzing, synthesizing, or deriving a concept. Work through each step and summarize a new definition of a concept. Formulate the work into a scholarly paper suitable for publication using the selected system.

3. For a scholarly or clinical research project, clarify a concept of interest using one of the above methods of concept development, clarification, or analysis. As an empirical part of the paper, locate an instrument with which the concept may be measured or operationalized.

4. As a thesis or research project use one of the above methods of advanced concept development to derive a concept for the discipline of nursing. Exhaustively review the literature and collect data from either clients or other professionals to use to develop the concept and determine empirical referents. Determine a method to measure the concept and analyze the data using quantitative and qualitative methods. Write a paper summarizing the process suitable for publication to inform the nursing profession of the newly derived concept.

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C H A P T E R

Theory Development:

Structuring Conceptual Relationships in Nursing

4

M e l a n i e M c E w e n

J

ill Watson is enrolled in a master’s nursing program and beginning work on her thesis. As an occupational health nurse at a large telecommunication manufacturing company for the past 7 years, Jill has concentrated much of her practice in the area of health promotion. She has organized numerous health fairs, led countless health help sessions, regularly posted health information on central bulletin boards, and provided screening programs for many illnesses. Despite her efforts to improve the health of the workers, many still smoke, are overweight, do not exercise, and have other negative lifestyle habits. Realizing that lack of information about health-related issues is not a problem, Jill has focused on trying to understand why people choose not to engage in positive health practices. As a result, she became interested in the concept of motivation.

In one of her early courses in her master’s program, Jill completed an analysis of the concept of health motivation. During this exercise she defined the concept; identified antecedents, consequences, and empirical referents; and developed a number of case studies including a model case, a related case, and a contrary case.

As her studies progressed, Jill reviewed the literature from nursing, psychology, and sociology on health beliefs and health motivation and discovered several related theories. The Health Belief Model appeared to best describe her impressions of the issues at hand, but the model had not been developed for nursing and did not completely fit her conceptualization of the variables and issues in health motivation.

For her thesis she decided to modify the Health Belief Model to focus on the concept of health motivation and to develop an instrument to measure the variables she had generated in her earlier work.

In nursing, theories are systematic explanations of events in which constructs and concepts are identified; relationships are proposed; and predictions are made to describe, explain, predict, or prescribe practice and research (Dickoff, James, & Wiedenbach,

1968; Streubert-Speziale & Carpenter, 2008). Without nursing theory, nursing activities and interventions are guided by rote, tradition, some outside authority, hunches, or they may simply be random.

Theories are not discovered; instead, they are invented to describe, explain, or understand phenomena or solve nagging problems (e.g., Why don’t people apply knowledge of positive health practices?). In the past, nursing leaders saw theory development as a means of clearly establishing nursing as a profession, and throughout the last 50 years, many nursing scholars developed models and theories to guide nursing practice, nursing research, nursing administration and management, and nursing educa- tion. As discussed in Chapter 2, these models and theories have been created at different levels (grand, middle range, practice) and for different purposes (description, explanation, prediction, etc.).

Theory development seeks to help the nurse understand practice in a more com- plete and insightful way and provides a method of identifying and expressing key ideas about the essence of practice. Theories help organize existing knowledge and aid in making new and important discoveries to advance practice (Walker & Avant, 2005).

As illustrated in the above case study, development and application of nursing theory are essential to revise, update, and refine the practice of nursing and to further advance the profession.

Overview of Theory Development

Several terms related to the creation of theory are found in the nursing literature. The- ory construction, theory development, theory building, and theory generation are sometimes used synonymously or interchangeably. In other cases (Cesario, 1997; Walker &

Avant, 2005), authors have differentiated the concepts or subsumed one term as a com- ponent or process within another. In this chapter, the term theory developmentis used as the global term to refer to the processes and methods used to create, modify, or refine a theory. Theory constructionis used to describe one of the final steps of theory development in which the components of the theory are organized and linkages specified.

Theory development is a complex, time-consuming process that covers a number of stages or phases from inception of concepts to testing of theoretical propositions through research (Powers & Knapp, 2006). In general, the process of theory development begins with one or more concepts that are derived from within a discipline’s metatheory or philosophy. These concepts are further refined and related to one another in propositions or statements that can be submitted to empirical testing (Chinn

& Kramer, 2008; Peterson, 2008; Reynolds, 1971).

Categorizations of Theory

As described in Chapter 2, theories are often categorized using different criteria. The- ories may be grouped based on scope or level of abstraction (grand theory, middle range theory, practice theory), the purpose of the theory, or the source or discipline in which the theory was developed.

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