One of the most contemporary methods for theory evaluation was presented by Dudley-Brown (1997), who strongly relied on Kuhn’s (1977) criteria for theory eval- uation. In this method, evaluation should consider accuracy, consistency, fruitfulness, simplicity!complexity, scope, acceptability, and sociocultural utility.
To Dudley-Brown (1997), accuracyis essential because the theory should describe nursing as it exists today—not the nursing of the future or of the past. The theory should contain a worldview of nursing consistent with the present reality. Consistency relates to the importance of the nursing theory being internally consistent. There should be logical order; terms, concepts, and statements should be used consistently and defined operationally; they should be coherent, and presented logically.
Another criterion Dudley-Brown (1997) identifies for evaluation is fruitfulness.
For this criterion, the theory should be useful in generating information and signifi- cant in contributing to the development of nursing knowledge.
Simplicity/complexityis a fourth criterion for evaluation. Both simple and complex theories are needed. In general, a theory should be balanced and logical. The theory should describe the phenomenon consistently in terms of simplicity or complexity.
Scope is a fifth criterion because theories of both broad and limited scope are needed. Scope should be dependent on the phenomenon and its context. Acceptance refers to the adoption of the theory by others. Theories should be useful in practice, education, research, or administration.
Sociocultural utilityis the final criterion for evaluation. Social congruence encom- passes the beliefs, values, and expectations of different cultures. The theory should be Level of Theory Basic Considerations Internal Analysis and
Evaluation External Analysis and
Evaluation Practice theory Can the concepts be
operationalized? Are operationalized concepts congruent with empirical data? Do statements lead to directives for nursing care? Are statements sufficient to practice and not contradictory?
Are there gaps or inconsistencies within the theory that may lead to conflicts and difficulties? Are assumptions congruent with nursing’s historical perspective? Are assumptions congruent with ethical standards and social policy? Are assumptions in conflict with given cultural groups?
Is the theory produced with existing nursing standards? Is the theory consistent with existing standards of education within nursing? Is the theory related to nursing diagnoses and nursing intervention practices? Is the theory supported by existing research internal and external to nursing?
Middle range
theory What are the definitions and relative importance of major concepts? What is the type and relative importance of major theoretical statements?
What are the assumptions of the theory? What is the relationship of the theory to philosophy of science positions? Are concepts related/not related via
statements? Is there internal consistency and congruency of all component parts of the theory? What is the empirical adequacy of the theory? Has the theory been examined in practice and research and has it held up to this scrutiny?
What is the congruency with related theory and research internal and external to nursing? What is the congruence with the perspective of nursing, the domains, and the
persistent questions?
What ethical, cultural, and social policy issues are related to the theory?
Nursing models What are the definitions of person, nursing, health, and environment? What are additional understandings of the metaparadigm concepts? What are the interrelationships among the metaparadigm concepts? What are the descriptions of other concepts found in the model?
What are the underlying assumptions of the model? What are the definitions of other components of the model? What is the relative importance of basic concepts or other components of the model? What are the analyses of internal and external consistency? What are the analyses of adequacy?
Is nursing research based on the model or related to the model? Is nursing education based on the model or related to the model? Is nursing practice based on the model? What is the relationship to existing nursing diagnoses and interventions systems?
TABLE 5-4
Criteria for Analysis and Evaluation of Theory: Whall
measured against the criterion of social utility according to the culture for which it was proposed. Theories proposed for Western societies need to be evaluated for their philosophical and theoretical relevance in other societies and cultures.
Comparisons of Methods
Several authors (Dudley-Brown, 1997; Moody, 1990; Alligood, 2006) have compared many of the theory analysis and evaluation methods described here. A number of sim- ilarities can be found between and among all the methods. Table 5-5 provides a list of the methods reviewed and criteria specified by each author. It is important to note that different authors use different terms for similar concepts; thus, some interpretation of meaning of terms was necessary for the comparison.
As Table 5-5 shows, the most common criteria identified among the theory evaluation methods were an examination of complexity!simplicity (7 of 9) and scope!generality (7 of 9 methods). Other common criteria were inclusion of meaning- ful terminology, definitions of concepts (6 of 9), consistency (6 of 9), contribution to understanding (5 of 9), usefulness (6 of 9), testability (4 of 9), logical adequacy (4 of 9), and validity!accuracy!empirical adequacy (4 of 9). Criteria mentioned in only one or two methods were implicit values of the theorist, information generation, reality con- vergence, discrimination between nursing and other health professions, consequences, method of development, correspondence to existing standards, origins of the theory, context, pragmatic adequacy, and application of or to nursing therapeutics.
There appears to be an evolution of the processes over the past three decades. Simi- larities of criteria were evident based on time of initial writing. Ellis, Duffey and Muhlenkamp, and Hardy were the first nurses to describe the processes of theory evalu- ation and their criteria are similar. The methods proposed by Walker and Avant are also consistent with those of Hardy and Ellis. Fawcett’s model is similar to Chinn and Kramer’s approach and to Barnum’s internal criticism criteria. Meleis and Whall present the most detailed methods. Meleis’ system has three components (description, analysis, and critical reflection) and Whall’s examines three levels of theory. Barnum and Whall are similar in that they describe separate internal and external dimensions. The later works of Whall, Meleis, and Dudley-Brown are similar because they include characteristics of cir- cle of contagion and consideration of social and cultural significance as evaluation criteria.
Most methods for analysis and evaluation were developed and used to review grand nursing theories. Indeed, a literature review resulted in no published report of theory evaluation in nursing beyond those in nursing theory textbooks. Books that focus on analysis and evaluation of grand nursing theories include those by Fawcett (1993, 1995, 2000, 2005), Fitzpatrick and Whall (1996), Whall (2005), George (2002), McQuiston and Webb (1995), and Tomey and Alligood (2006). Peterson and Bredow (2008) and Tomey and Alligood (2006) also analyze!evaluate selected middle range nursing theories in their works.
Synthesized Method of Theory Evaluation
Following the detailed review and comparison of the many methods for theory anal- ysis and evaluation, a method specifically designed to evaluate middle range and prac- tice theories was developed (Box 5-3). These criteria were synthesized from the works of noted nursing scholars described above and are intended to be contemporary and responsive to both recent and anticipated changes in use of theory in nursing practice, research, education, and administration.
Summary
Nurses in clinical practice, as well as graduate students like Jerry Thompson from the case study, should know how to analyze or evaluate a theory to determine if it is reli- able and valid and to determine when and how to apply it in practice, research, admin- istration, or education. This chapter has presented and analyzed a number of different TABLE 5-5Comparison of Theory Evaluation Criteria
Evaluation Criteria Ellis Hardy Barnum Walker Fawcett Chinn Meleis Whall Dudley-
and and Brown
Avant Kramer
Complexity/simplicity X X X X X X X
Testability X X X X
Generality/scope X X X X X X X
Usefulness X X X X X X
Contribution to X X X X X
understanding
Implicit values X X
Information generation X
Meaningful terminology X X X X X X
(definitions)
Logical adequacy X X X X
Validity/accuracy/ X X X X
empirical adequacy
Predictability/tested X X X
Origins X X
Clarity X X X
Consistency X X X X X X
Context X X
Pragmatic adequacy X X
Reality convergence X
Discrimination X
Metaparadigm concepts X X X
Assumptions X X X
Purpose X X
Consequences X
Nursing therapeutics X X
interventions
Method of development X
Circle of contagion X X X
Social/cultural X X X
significance
Correspondence to X X
standards/professional values
THEORY DESCRIPTION
What is the purpose of the theory? (describe, explain, predict, prescribe)
What is the scope or level of the theory? (grand, middle range, practice)
What are the origins of the theory?
What are the major concepts?
What are the major theoretical propositions?
What are the major assumptions?
Is the context for use described?
THEORY ANALYSIS
Are concepts theoretically and operationally defined?
Are statements theoretically and operationally defined?
Are linkages explicit?
Is the theory logically organized?
Is there a model/diagram? Does the model con- tribute to clarifying the theory?
Are the concepts, statements, and assumptions used consistently?
Are outcomes or consequences stated or pre- dicted?
THEORY EVALUATION
Is the theory congruent with current nursing stan- dards?
Is the theory congruent with current nursing inter- ventions or therapeutics?
Has the theory been tested empirically? Is it sup- ported by research? Does it appear to be accu- rate/valid?
Is there evidence that the theory has been used by nursing educators, nursing researchers, or nursing administrators?
Is the theory socially relevant?
Is the theory relevant cross-culturally?
Does the theory contribute to the discipline of nursing?
What are implications for nursing related to imple- mentation of the theory?
BOX 5-3
Synthesized Method for Theory Evaluation
methods for evaluation of theory. Like many issues in the study of use of theory in nursing, the process of theory evaluation, although important, is often confusing. In addition, with very few exceptions, the methods or techniques were developed and used almost exclusively to analyze and evaluate grand nursing theories. It is hoped that with the current emphasis on development and use of both practice and middle range theories, there will be a concurrent emphasis on the analysis and evaluation of those theories.
The most commonly used methods were described in some detail and compared.
Following this comparison, a synthesized and simplified method for examination of theory was presented. To further help the reader understand this process, this chapter presents an exemplar of the proposed theory evaluation method.
T
HEORY EVALUATION EXEMPLAR: THEORY OF CHRONIC SORROWBurke, M. L., Eakes, G. G., & Hainsworth, M. A. (1999). Milestones of chronic sorrow: Perspectives of chronically ill and be- reaved persons and family caregivers. Journal of Family Nursing, 5(4), 374–387.
Eakes, G. G. (1993). Chronic sorrow: A response to living with cancer. Oncology Nursing Forum, 20 (9), 1327–1334.
Eakes, G. G. (1995). Chronic sorrow: The lived experience of parents of chronically mentally ill individuals. Archives of Psychiatric Nursing, 9 (2), 77–84.
Eakes, G. G. (2009). Chronic sorrow. In S. J. Peterson and T. S. Bredow (Eds.), Middle range theories: Application to nursing re- search (2nd ed., pp 149–160). Philadelphia: Lippincott Williams & Wilkins.
Eakes, G. G, Burke, M. L., & Hainsworth, M. A. (1998). Middle-range theory of chronic sorrow. Image: Journal of Nursing Scholarship, 30 (2), 179–185.
Hainsworth, M. A. (1995). Chronic sorrow in women with chronically mentally disabled husbands. Journal of the American Psychiatric Nurses Association, 1(4), 120–124.
Hobdell, E. (2004). Chronic sorrow and depression in parents of children with neural tube defects. Journal of Neuroscience Nursing, 36 (2), 82–84.
Hobdell, E. F., Grant, M. L., Valencia, I., Mare, J., Kothare, S. V., Legido, A., & Khurana, D. S. (2007). Chronic sorrow and cop- ing in families of children with epilepsy. Journal of Neuroscience Nursing, 39 (2), 76–83.
Isaksson, A. K., & Ahlstrom, G. (2008). Managing chronic sorrow: Experiences of patients with multiple sclerosis. Journal of Neuroscience Nursing, 40 (3), 180–192.
Kendall, L. C. (2005). The experience of living with ongoing loss: Testing the Kendall chronic sorrow instrument (Doctoral dis- sertation, Virginia Commonwealth University).
Langridge, P. (2002). Reduction of chronic sorrow: A health promotion role for children’s community nurses? Journal of Child Health Care, 6 (3), 157–170.
Lowes, L., & Lyne, P. (2000). Chronic sorrow in parents of children with newly diagnosed diabetes: A review of the literature and discussion of the implications for nursing practice. Journal of Advanced Nursing, 32 (1), 41–48.
Melvin, C. S., & Heater, B. S. (2004). Suffering and chronic sorrow: Characteristics and a paradigm for nursing interventions.
International Journal for Human Caring, 8 (2), 41–47.
Northington, L. (2000). Chronic sorrow in caregivers of school aged children with sickle cell disease: A grounded theory ap- proach. Issues in Comprehensive Pediatric Nursing, 23 (2), 141–154.
Schreier, A. M., & Droes, N. S. (2006). Georgene Gaskill Eakes, Mary Lermann Burke, and Margaret A. Hainsworth: Theory of Chronic Sorrow. In A. M. Tomey & M. R. Alligood (Eds.), Nursing theorists and their work (6th ed., pp. 679–695). St. Louis:
Mosby.
Theory Description Scope of theory: Middle range
Purpose of theory: Explanatory theory—“to explain the experiences of people across the lifespan who encounter ongoing disparity because of significant loss” (p. 179).
Origins of theory: “Chronic sorrow” appeared in the literature in 1962 to describe recurrent grief experi- enced by parents of children with disabilities. A number of research projects were conducted in the 1980s and 1990s describing chronic sorrow among various groups with loss situations. The resulting Theory of Chronic Sorrow, therefore, was inductively developed using concept analysis, extensive re- view of the literature, critical review of research, and validation in 10 qualitative studies of various loss situations.
Major concepts: Chronic sorrow, loss experience, disparity, trigger events (milestones), external manage- ment methods, internal management methods. All are defined and explained.
Major theoretical propositions are as follows:
1. Disparity between a desired relationship and an actual relationship or a disparity between current re- ality and desired reality is created by loss experiences.
2. Trigger events bring the negative disparity into focus or exacerbate the experience of disparity.
3. For individuals with chronic or life-threatening illnesses, chronic sorrow is most often triggered when the individual experiences disparity with accepted norms (social, developmental, or personal).
4. For family caregivers, disparity between the idealized and actual is associated with developmental milestones.
5. For bereaved individuals, disparity from the ideal is created by the absence of a person who was cen- tral in the life of the bereaved.
Major assumptions: Not stated
Context for use: “Experienced by individuals across the lifespan”; implied that it may be used in multiple settings and nursing situations.
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).