Theory Analysis
Theoretical definitions for major concepts:
Chronic sorrow—the periodic recurrence of permanent, pervasive sadness or other grief-related feelings associated with ongoing disparity resulting from a loss experience
Loss experience—a significant loss, either actual or symbolic, that may be ongoing, with no predictable end, or a more circumscribed single-loss event
Disparity—a gap between the current reality and the desired as a result of a loss experience
Trigger events or milestones—a situation, circumstance, or condition that brings the negative disparity resulting from the loss into focus or exacerbates the disparity
External management methods—interventions provided by professionals to assist individuals to cope with chronic sorrow
Internal management methods—positive personal coping strategies used to deal with the periodic episodes of chronic sorrow
Operational definitions for major concepts: No operational definitions are provided.
Statements theoretically defined: Theoretical propositions are implicitly stated in the body of the text.
Statements operationally defined: Theoretical propositions are not operationally defined.
Linkages explicit: Linkages are described in the text and explicated in the model.
Logical organization: Theory is logically organized and described in detail.
Model/diagram: A model is provided and assists in explaining linkages of the concepts (see p. xx).
Consistent use of concepts, statements, and assumptions: Concepts and propositions are used consis- tently. Assumptions are not explicitly addressed.
Predicted or stated outcomes or consequences: Outcomes are stated.
Theory Evaluation
Congruence with nursing standards: The theory appears congruent with nursing standards. A number of articles were identified in recent nursing literature describing how the construct of chronic sorrow has been identified among various aggregates (Eakes, 2009).
Congruence with current nursing interventions or therapeutics: Literature-based descriptions of applica- tion of components of the theory in nursing practice include caring for bereaved persons and family caregivers (Burke, Eakes, & Hainsworth, 1999), a discussion of caring for children with newly diag- nosed diabetes (Lowes & Lyne, 2000), interventions for community nurses to help assist families re- solving chronic sorrow (Langridge, 2002), and interventions for suffering related to chronic sorrow (Melvin & Heater, 2004).
Evidence of empirical testing/research support/validity : The theory was derived from multiple research studies and a review of the literature.
The Burke/CCRCS Chronic Sorrow Questionnaire is an interview guide comprising 10 open-ended questions that explore the theory’s concepts.
Research using the questionnaire includes investigation of chronic sorrow among cancer patients (Eakes, 1993), chronic sorrow in chronically mentally ill individuals (Eakes, 1995), chronic sorrow in women with mentally disabled husbands (Hainsworth, 1995), chronic sorrow in parents of children with neural tube defects (Hobdell, 2004), chronic sorrow and cooping in families of children with epilepsy (Hobdell et al., 2007), and chronic sorrow among patients with multiple sclerosis (Isaksson
& Ahlstrom, 2008). Further, a second instrument designed to measure chronic sorrow (Kendall, 2005) has been developed.
Use by nursing educators, nursing researchers, or nursing administrators: The above references indicate that the theory has been used in practice and research. Other studies have cited the work of Eakes, Burke, and Hainsworth related to chronic sorrow (e.g., Northington, 2000).
Social relevance: Theory is relevant to individuals, families, and groups, irrespective of age or socioeco- nomic status.
Transcultural relevance: Theory is potentially relevant across cultures; theorist notes that “relevance for various cultural groups should be explored” (Eakes, Burke, & Hainsworth, 1998, p. 184).
Contribution to nursing: Authors note that the theory is applicable to different groups, but more study is needed to test the theory and to identify strategies to reduce disparity created by loss (prescriptive interventions). Despite the relative newness of the theory, there is a growing body of nursing litera- ture reporting on use both related to interventions and research (Eakes, 2009).
Conclusions and implications: The theory is useful and appropriate for nurses practicing in a variety of settings. Implications for research were described and implications for education can be inferred.
Further development of the theory is warranted to better explicate relationships and operationalize the concepts and propositions to allow testing.
LEARNING ACTIVITIES
1. Obtain the original works of two of the nursing scholars whose theory analysis/
evaluation strategies are discussed. Use the strategies to evaluate a recently pub- lished middle range nursing theory (see Chapter 11 for examples). How are the conclusions similar? How are they different?
2. For one of the nursing scholars who has published several versions or editions of her work (e.g., Fawcett, Chinn & Kramer, Meleis), obtain a copy of the oldest
version and a copy of the most recent version and compare the strategies sug- gested. Have they changed?
3. Use the synthesized method for theory evaluation to evaluate a grand nursing theory. Compare findings with published evaluations of the same theory. How are conclusions similar? How are they different?
4. Search the literature for examples of published accounts of nursing theory evalua- tion or theory analysis. Share your findings with classmates.
REFERENCES
Alligood, M. R. (2006). Introduction to nursing theory:
Its history, significance and analysis. In A. M. Tomey &
M. R. Alligood (Eds.), Nursing theorists and their work (6th ed., pp. 3–15). St. Louis: Mosby.
Barnum, B. S. (1984). Nursing theory: Analysis, application, evaluation(2nd ed.). Boston: Little Brown.
Barnum, B. S. (1990). Nursing theory: Analysis, application, evaluation(3rd ed.). Glenview, IL: Scott, Foresman/
Little, Brown Higher Education.
Barnum, B. S. (1994).Nursing theory: Analysis, application, evaluation(4th ed.). Philadelphia: Lippincott.
Barnum, B. S. (1998). Nursing theory: Analysis, applica- tion, evaluation(5th ed.). Philadelphia: Lippincott Williams & Wilkins.
Chinn, P. L., & Kramer, M. K. (1987). Theory and nursing:
A systematic approach(2nd ed.). St. Louis: Mosby.
Chinn, P. L., & Kramer, M. K. (1991). Theory and nursing:
A systematic approach(3rd ed.). St. Louis: Mosby.
Chinn, P. L., & Kramer, M. K. (1995).Theory and nursing:
A systmetic approach(4th ed.). St. Louis: Mosby.
Chinn, P. L., & Kramer, M. K. (1999). Theory and nurs- ing: Integrated knowledge development(5th ed.). St.
Louis: Mosby.
Chinn, P. L., & Kramer, M. K. (2004). Integrated theory and knowledge development in nursing (6th ed.). St.
Louis: Mosby.
Chinn, P. L., & Kramer, M. K. (2008). Integrated theory and knowledge development in nursing (7th ed.). St.
Louis: Mosby.
Dudley-Brown, S. L. (1997). The evaluation of nursing theory: A method for our madness. International Jour- nal of Nursing Studies, 34(1), 76–83.
Duffey, M., & Muhlenkamp, A. F. (1974). A framework for theory analysis. Nursing Outlook, 22(9), 570–574.
Ellis, R. (1968). Characteristics of significant theories.
Nursing Research, 17(3), 217–222.
Fawcett, J. (1980). A framework of analysis and evaluation of conceptual models of nursing. Nurse Educator, 5(6), 10–14.
Fawcett, J. (1993). Analysis and evaluation of nursing the- ories. Philadelphia: Davis.
Fawcett, J. (1995). Analysis and evaluation of conceptual models of nursing(3rd ed.). Philadelphia: Davis.
Fawcett, J. (2000). Analysis and evaluation of contempo- rary nursing knowledge: Nursing models and theories.
Philadelphia: Davis.
Fawcett, J. (2005). Contemporary nursing knowledge:
Analysis and evaluation of nursing models and theories (2nd ed.). Philadelphia: F. A. Davis.
Fitzpatrick, J. J., & Whall, A. (1989). Conceptual models of nursing: Analysis and application(2nd ed.). Norwalk, CT: Appleton & Lange.
Fitzpatrick, J. J., & Whall, A. L. (1996). Conceptual models of nursing: Analysis and application(3rd ed.).
Norwalk, CT: Appleton & Lange.
Fitzpatrick, J. J., & Whall, A. (2005). Conceptual models of nursing: Analysis and application(4th ed.). Upper Saddle River, NJ: Prentice Hall.
George, J. B. (2002). Nursing theories: The base for profes- sional nursing practice(5th ed.). Upper Saddle River, NJ: Prentice-Hall.
Hardy, M. E. (1974). Theories: Components, development, evaluation. Nursing Research, 23, 100–107.
Hardy, M. E. (1978). Perspectives on nursing theory.
Advances in Nursing Science, 1(1), 27–48.
Hickman, J. S. (2002). An introduction to nursing theory.
In J. B. George (Ed.), Nursing theories: The base for professional nursing practice(5th ed.). Upper Saddle River, NJ: Prentice-Hall.
Kuhn, T. S. (1977). Second thoughts on paradigms.
In F. Suppe (Ed.), The structure of scientific theory (pp. 459–482). Urbana, IL: University of Illinois Press.
McQuiston, C. M., & Webb, A. A. (1995). Foundations of nursing theory: Contributions of 12 key theorists.
Thousand Oaks, CA: Sage.
Meleis, A. I. (1985). Theoretical nursing: Development and progress. Philadelphia: J. B. Lippincott.
Meleis, A.I. (1991). Theoretical nursing: Development and progress(2nd ed.). Philadelphia: Lippincott Williams &
Wilkins.
Melies, A. I. (1997). Theoretical nursing: Development and progress(3rd ed.). Philadelphia: Lippincott Williams &
Wilkins.
Meleis, A. I. (2007). Theoretical nursing: Development and progress(5th ed.). Philadelphia: Lippincott Williams &
Wilkins.
Moody, L. E. (1990). Advancing nursing science through research. Newbury Park, CA: Sage.
Pender, N. J., Murdaugh, C. L., & Parsons, M. H.
(2006). Health promotion in nursing practice(5th ed.).
Upper Saddle River, NJ: Prentice-Hall.
Peterson, S. J., & Bredow, T. S. (2008). Middle range theories: Application to nursing research(2nd ed.).
Philadelphia: Lippincott Williams & Wilkins.
Stevens, B. J. (1979). Nursing theory: Analysis, application, evaluation. Boston: Little, Brown.
Walker, L. O., & Avant, K. (1983). Strategies for theory construction in nursing. Norwalk, CT: Appleton- Century-Crofts.
Walker, L. O., & Avant, K. (1988). Strategies for theory construction in nursing(2nd ed.). Norwalk, CT:
Appleton & Lange.
Walker, L. O., & Avant, K. (1995). Strategies for theory construction in nursing(3rd ed.). Norwalk, CT:
Appleton & Lange.
Walker, L. O., & Avant, K. (2005). Strategies for theory construction in nursing(4th ed.). Upper Saddle River, NJ: Prentice-Hall.
Whall, A. L. (2005). The structure of nursing knowledge:
Analysis and evaluation of practice, middle range and grand theory. In J. J. Fitzpatrick & A. L. Whall (Eds.), Concep- tual models of nursing: Analysis and application(3rd ed., pp. 13–51). Upper Saddle River, NJ: Prentice-Hall.
U N I T
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Nursing Theories
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C H A P T E R
Overview of Grand Nursing Theories
6
E v e l y n W i l l s
J
anet Turner works as a nurse on a postsurgical, cardiovascular floor. Because she desires a broader view of nursing knowledge and wants to become a clinical specialist or acute care nurse practitioner, she recently began a master’s degree program. The requirements for a course titled “Theoretical Foundations of Nursing” led Janet to become familiar with the many nursing theories. From her readings she learned about a number of ways to classify theories: grand theory, conceptual model, middle range theory, practice theory, borrowed theory, interactive–integrative model, totality paradigm, and simultaneous action paradigm. She came to the conclusion that there is no cohesion among authors of nursing theory.A large proportion of Janet’s theory course consisted of distance learning methods. To express her frustration and to try to understand the material, she consulted with her theory professor via the web-based live chat room that was part of the course. The entire class eventually logged on to the chat and a long discussion resulted in which students shared interesting ways of conceptualizing grand nursing theories. The chat broke up with the agreement that each student would review the assigned readings and return to next week’s live chat ready to discuss the findings.
Janet became frustrated when she concluded that each of the theories was very different and she wondered how she would ever understand them. But, as she continued to study and work with her professor and classmates, she learned that nursing theory has evolved from several schools of philosophical thought and various scientific traditions. To better understand the theories, she looked for ways to group or categorize them based on similarities of perspective. As she studied theories based on similar perspectives, she was able to read and analyze the theories more effectively, and to select three that she intended to examine further.
In Chapter 2, the reader was introduced to grand nursing theories and given a brief his- torical overview of their development. Fawcett (2005) distinguishes between concep- tual models and grand theories, and this chapter discusses that differentiation in an
effort to assist beginning graduate nursing students to understand the material. Accord- ing to Fawcett (2005), conceptual models are broad formulations of philosophy that are based on an attempt to include the whole of nursing reality as the scholar understands it. The concepts and propositions are abstract and not likely to be testable in fact. Grand nursing theories, by contrast, may be derived from conceptual models and are the most complex and widest in scope of the levels of theory; they attempt to explain broad issues within the discipline. Grand theories are composed of relatively abstract concepts and typically lack operational definitions; propositions are abstract and are not directly amenable to testing (Fawcett, 2005; Higgins & Moore, 2000). They were developed through thoughtful and insightful appraisal of existing ideas as opposed to empirical research and may incorporate numerous other theories (Figure 6-1).
The grand nursing theories guide research and assist scholars to integrate the results of numerous diverse investigations so that the findings may be applied to education, practice, further research, and administration. Grand theories provide a background of philosophical reasoning that allow nurse scientists to develop an organizing theory for research or practice, sometimes referred to as a middle range theory. (Middle range the- ories will be discussed in Chapters 10 and 11.) One of the most important benefits of invoking theories in education, administration, research, and practice has been the sys- tematization of those domains of nursing activity.
Practitioners are more likely to succeed in analyzing research into evidence for util- ity of tested interventions using meta-analysis for evidence-based practice (EBP) when the research fits into a particular theoretical framework. Cody (2003) states that “nurs- ing theory guided practice can be shown to enhance health and quality of life when it is implemented with strong, well-qualified guidance” (p. 167). Mark, Hughes, and Jones (2004) echo his beliefs and posit that theory-guided research results not only in
Conceptual Model (Grand Theory)
Social Needs (theory of) Spiritual Needs
(theory of) Human Activities
(theory of)
Hypothesis on Activity Outcomes
Hypothesis on Healing With Prayer
Hypothesis on ICU Visitation
FIGURE 6-1Relationship of conceptual model, theory, and hypotheses.
greater patient safety, but also in more predictable outcomes. These beliefs among nursing scientists provide clear direction that theory-guided research is necessary in testing implementation of interventions in practice.
Over the last five decades of theory development, review of the health care liter- ature demonstrates that changes in health care, society, and the environment, as well as changes in population demographics (i.e., aging, urbanization, increase in minorities), led to a need to renew or update existing theories and to develop dif- ferent theories. Health care delivery is a constantly changing process, and to be rel- evant to health care, theories require constant renewal and reevaluation. Indeed, many established nursing theorists continue to write, reevaluate, and improve their theories in light of these changes. Inspiration for many of the newer theories is linked not only to the changes in the health sciences, but also to changes in society worldwide (Boykin & Schoenhofer, 2001). Such theorists as Roper, Logan, and Tierney (United Kingdom), Ray (Canada), and Martinson (Norway) have achieved worldwide recognition. This chapter introduces conceptual frameworks and grand nursing theories. Chapters 7, 8, and 9 provide additional information about some of the more commonly known and widely recognized nursing frameworks and the- ories. To better assist the reader in understanding the conceptual frameworks and grand nursing theories, this chapter presents methods for categorizing or classifying them, and describes the criteria that will be used to examine them in the subsequent chapters.
Categorization of Conceptual Frameworks and Grand Theories
The sheer number and scope of the conceptual frameworks and grand theories are daunting. Students and novice nursing scholars are understandably intimidated when asked to study them, as illustrated in the opening case study. To help understand the formulations, a number of methods categorizing them have been described in the nursing literature. Several are presented in the following sections.