Associate Professor University of Texas Health Science Center at Houston School of Nursing Houston, Texas. Professor SLEMCO/BoRSF Regents Professor of Nursing Department of Nursing College of Nursing and Allied Health Professions University of Louisiana at Lafayette Lafayette, Louisiana.
Cynthia Ayres, PhD, RN
Rae Langford, EdD
Hélène Sylvain, PhD
This book came out of the frustration felt by a group of nursing instructors who came together to adopt a textbook for a theory course. In order to collect more data on theory courses and related information from a wider group of theory instructors, a nationwide survey was conducted.
ORGANIZATION OF THE TEXT
In this unit, we have identified some of the most important theories that have been developed outside the discipline of nursing, but are constantly used in nursing. Finally, Unit IV, Application of Theory in Nursing, explains how theories are used in nursing.
KEY FEATURES
These chapters also provide original references and provide examples of how the concepts, theories and models described have been used by other nurses. The increased development of practice theories and guidelines for evidence-based practice (EVP) is essential to the application of theory in nursing today, so these areas have expanded.
NEW TO THIS EDITION
On the other hand, many characteristics of the profession can be observed in nursing. It examines the schools of philosophical thought that have influenced nursing and explores nursing epistemology to explain why recognizing multiple “ways of knowing” is an important concept in seeking to develop and apply theory in nursing.
OVERVIEW OF SCIENCE
The chapter concludes with a case study depicting how the "ways of knowing" in nursing are used in everyday life, even moment by moment, by all practicing nurses. It has been argued that although nursing draws on the basic and pure sciences (eg, physiology and chemistry) and has many characteristics of social science, it is an applied or practice science.
OVERVIEW OF PHILOSOPHY
In the period of modern science, three philosophies of science dominate: rationalism, empiricism and human sciences/phenomenology. Rationalism and empiricism are often referred to as accepted views, and humanities/phenomenology and related worldviews (i.e. historicism) are considered perceived views (Hickman, 2002; Meleis, 2005; Moody, 1990).
RECEIVED VIEW (EMPIRICISM, POSITIVISM, LOGICAL POSITIVISM)
Indeed, modern empiricists or postpositivists have been observed to be concerned with explaining and predicting complex phenomena, recognizing contextual variables (Powers & Knapp, 2006; Reed, 2008). As DiBartolo (1998) stated, “the majority of nurses now agree that the received view is fundamentally incompatible with the discipline's complex philosophical commitment to holism and the humanistic approach, so it has essentially been discarded as a basis for science of nursing” (p. 353).
PERCEIVED VIEW (HUMAN SCIENCE, PHENOMENOLOGY, CONSTRUCTIVISM, HISTORICISM)
In nursing, the dichotomy of philosophical thought between the received, empirical view of science and the observed, interpretive view of science continued. The terms nursing philosophy, nursing science and philosophy of science in nursing are sometimes used interchangeably.
NURSING PHILOSOPHY
NURSING SCIENCE
PHILOSOPHY OF SCIENCE IN NURSING
EPISTEMOLOGY
In another work, Moch (1990) identified these patterns: experiential knowledge (becoming aware of participating in or being in the world), interpersonal knowing (a Table 1-4 Characteristics of Carper's Patterns of Knowing in Nursing). the multiple ways of knowing are recognized in nursing.
NURSING AS A PRACTICE SCIENCE
In the 1960s and 1970s, nursing schools aligned the nursing survey with the scientific inquiry in a desire to bring respectability to the academic environment, and nurse researchers and nurse educators valued quantitative research methods over other forms. However, a debate about methodology began in the 1980s when some nursing researchers argued that the ontology of nursing (what nursing is) was not sufficiently and adequately explored using quantitative methods in isolation.
NURSING AS A HUMAN SCIENCE
In applied research, the investigator works to solve problems and create solutions to the problem. Thus, as an applied or practical science, nursing requires research that is applied and clinical (Fawcett, 1999).
QUANTITATIVE VERSUS QUALITATIVE METHODOLOGY DEBATE
It has been argued that there is an overvaluation of the empirical/quantitative view because it is seen as "true science" (Tinkle & . Beaton, 1983). The ethical knowledge of nursing is continuously used in nursing care to promote the health and well-being of the patient; and in these circumstances also the unborn child.
LEARNING ACTIVITIES
One of the first courses required by his program was entitled Application of Theory in Nursing. Some have promoted the idea that a single, unified model of nursing – a world view of the discipline – might emerge (Tierney, 1998).
FLORENCE NIGHTINGALE
These theories typically provide a detailed description of all components of the model and outline relationships in the form of statements. Many conceptual frameworks and theories also include a schematic drawing or model that represents the overall structure or interactivity of the components (Chinn &. Kramer, 2008).
STAGES OF THEORY DEVELOPMENT IN NURSING
In addition, there were 73 doctoral nursing practice (DNP) programs, with many more planned (American Association of Colleges of Nursing, 2008). In the 1960s, a number of nurse leaders (Abdellah, Orlando, Widenbach, Hall, Henderson, Levine, and Rogers) developed and published their views on nursing.
SUMMARY OF STAGES OF NURSING THEORY DEVELOPMENT
Attention has shifted from grand theories to medium-scale and practice or situation-specific theories, as well as the application of theory to research and practice. It is expected that the importance of applying mid-range theories and practice to research and practice will continue to be emphasized.
SCOPE OF THEORY
Graduate schools of nursing develop courses in how to analyze and apply theory 1980s in nursing. Examples of middle-range theories used in nursing include social support, quality of life, and health promotion.
TYPE OR PURPOSE OF THEORY
Another example of a situational or predictive theory in nursing can be found in the Caregiving Effectiveness Model. A number of issues related to the use of theory in nursing have received a lot of attention in the literature.
BORROWED VERSUS UNIQUE THEORY IN NURSING
NURSING’S METAPARADIGM
Furthermore, the four concepts and statements identify the unique focus of the nursing discipline and encompass all relevant phenomena in a parsimonious manner. It is a reflection of adaptation, that is, the interaction between the person and the environment.
CARING AS A CENTRAL CONSTRUCT IN THE DISCIPLINE OF NURSING
The Hahn School of Nursing Theory page contains links to sites with information on many major and mid-tier nursing theories. The Clayton College Department of Nursing's Nursing Theory Link page contains extensive links to sites with information on major and intermediate nursing theories.
TYPES OF CONCEPTS
At the other end of the continuum are abstract concepts (i.e. art, social support, personality, role). Relatively concrete or "empirical" concepts are formed from direct observations of objects, properties, or events.
SOURCES OF CONCEPTS
Research-based concepts are the result of conceptual development that is based on research processes. Other existing concepts commonly used in nursing research, administration, and practice are empathy, suffering, abuse, hope, and burnout.
PURPOSES OF CONCEPT DEVELOPMENT
CONTEXT FOR CONCEPT DEVELOPMENT
CONCEPT DEVELOPMENT AND CONCEPTUAL FRAMEWORKS
CONCEPT DEVELOPMENT AND RESEARCH
Strategies devised by various nurses will be briefly presented in the following sections, and examples of published work using these methods will be provided where available.
WALKER AND AVANT
Walker and Avant techniques have been taught in university nursing programs for more than twenty years, and it is the most widely used concept analysis technique in nursing. In their most recent edition, Walker and Avant (2005) outlined the processes for each of the methods described in detail and provide a number of examples for clarification.
RODGERS
The goal of the concept analysis will determine to some extent how the researcher identifies the concept of interest and selected terms and expressions. The main result of the evolutionary method of concept analysis is the generation of further questions for research rather than the static definition of the concept.
SWARTZ-BARCOTT AND KIM
The extent to which the literature review, theoretical analysis, and empirical findings support the presence and frequency of the concept in the population selected for empirical study. Elements that the researcher must consider when writing the findings are the length of the study, the intended audience, the timing, the pace of the authoring process, the expected length of the manuscript, how much detail of the process to include, and the ethics of interpreting the analysis. (Swartz-Barcott and Kim, 2000).
MELEIS
A new or refined way of measuring the concept may be the result (Swartz-Barcott & Kim, 1993). The aim of the analysis is to bring the concept closer to use in research or clinical practice and to ultimately contribute to instrument development and theory testing.
MORSE
Prerequisites - the status of the concept in nursing and its use in teaching or clinical practice. Determining antecedents Determining the contextual conditions in which the concept is perceived and expected to occur.
PENROD AND HUPCEY
COMPARISON OF MODELS FOR CONCEPT DEVELOPMENT
As an empirical part of the article, find an instrument that can measure or operationalize the concept. In one of her first courses in her master's program, Jill completed an analysis of the concept of health motivation.
CATEGORIZATION BASED ON SCOPE OR LEVEL OF ABSTRACTION
Compared to grand theories, medium-range theories contain a limited number of concepts and are limited in scope. Middle-range theories help to refine grand theories and directly prescribe theories of practice.
CATEGORIZATION BASED ON PURPOSE
Predictive theories describe precise relationships between concepts and are the third level of theory development. Prescriptive theories are considered the highest level of theory development (Dickoff et al., 1968).
CATEGORIZATION BASED ON SOURCE OR DISCIPLINE
PURPOSE
CONCEPTS AND CONCEPTUAL DEFINITIONS
THEORETICAL STATEMENTS
The nature of the association/correlation can be positive (when one concept occurs or is high, the other concept occurs or is high). The association may be neutral when the occurrence of one concept does not provide information about the occurrence of another concept.
STRUCTURE AND LINKAGES
In scientific research, the concept or variable that is the cause is usually called the independent variable and the variable that is affected is the dependent variable. A link between smoking and lung cancer was recognized as early as the 1940s, but it was not until the 1980s that it was determined that smoking actually caused lung cancer.
ASSUMPTIONS
MODELS
Finally, Artinian said that once a model is conceptually illustrated, the phenomenon represented can be examined in different settings to test the utility and generalizability of the underlying theory. The figure in the example at the end of the chapter shows a model that illustrates the relationships between the variables of the Care Effectiveness Model.
RELATIONSHIP AMONG THEORY, RESEARCH, AND PRACTICE
By creating a model of concepts and relationships, it is possible to trace the effect of certain variables on the outcome variable, rather than claiming that every variable under study is related to every other variable. Second, the nurse must be aware that there are different approaches to theory development based on the source of initiation (i.e., practice, theory, or
Research
She stated that models help illustrate the processes through which outcomes occur by specifying the relationships between the variables in graphical form where they can be examined for inconsistency, incompleteness, or error.
Theory
Practice
When tested empirically, the research results can be used to verify, modify, refute, or support a theoretical proposition. One of the most important applications of theory is to contribute to insights about nursing practice situations by setting goals for assessment, diagnosis and intervention.
APPROACHES TO THEORY DEVELOPMENT
Research-Theory The development of theory is based on research; theories evolve from repeated and confirmed research findings. In the theory-research-theory approach, theory guides the research questions and research results are used to modify the theory.
PROCESS OF THEORY DEVELOPMENT
The third phase in theory development involves structuring and contextualizing the components of the theory. The ultimate goal of theory evaluation is to determine the potential contribution of the theory to scientific knowledge.
THEORY DESCRIPTION
Theory evaluation does not generate new information beyond the boundaries of the theory, but it often leads to new insights about the theory under investigation. In nursing practice, theory evaluation can provide a clinician with additional knowledge about the reliability of the theory.
THEORY ANALYSIS
In addition, related works by others are examined to gain a clear understanding of the structural and functional components of the theory. Functional components consist of the concepts of a theory and their application to describe, explain, predict, or control (Meleis, 2007; Moody, 1990).
THEORY EVALUATION
CHARACTERISTICS OF SIGNIFICANT THEORIES: ELLIS
THEORY EVALUATION: HARDY
The entire set of relevant studies must be evaluated in terms of the extent to which it supports the theory or part of the theory. Finally, the criteria of usefulness and relevance refer to the use of the theory in controlling, changing, or manipulating key variables and conditions specified by the theory to realize a desired outcome.
THEORY ANALYSIS AND THEORY EVALUATION: DUFFEY AND MUHLENKAMP
THEORY EVALUATION: BARNUM
THEORY ANALYSIS: WALKER AND AVANT
THEORY ANALYSIS AND EVALUATION: FAWCETT
The evaluation is based on a review of previously published critiques, research reports, and reports on the practical application of the theory. During the theory evaluation process, the criteria to be examined are the explanation of the origin of the theory, the integrity of the content, its logical coherence, how well it can lead to the generation of new theory, its credibility, and how it has contributed to nursing (Fawcett, 2005).
THEORY DESCRIPTION AND CRITIQUE: CHINN AND KRAMER
Theory evaluation requires judgments to be made about the meaning of a theory (Fawcett, 1993) based on how it meets certain criteria (Fawcett, 2005).
THEORY DESCRIPTION, ANALYSIS, AND CRITIQUE: MELEIS
ANALYSIS AND EVALUATION OF PRACTICE THEORY, MIDDLE RANGE THEORY, AND NURSING MODELS: WHALL
In addition, conceptual models must take into account the most important paradigm concepts (person, environment, health and nursing) as well as additional concepts specific to the model. Internal analysis considers the assumptions and philosophical basis of the model and looks at the uniformity of discussion throughout the model.
THEORY EVALUATION: DUDLEY-BROWN
The assumptions of the theory must be considered in the light of historical and current perspectives of nursing. Several authors (Dudley-Brown, 1997; Moody, 1990; Alligood, 2006) have compared many of the theory analysis and evaluation methods described here.
LIFE SPAN
Further development of the theory is warranted to better explain relationships and operationalize the concepts and propositions to enable testing. One of the most important benefits of the appeal to theories in education, administration, research and practice has been the systematization of those domains of nursing activity.
CATEGORIZATION BASED ON SCOPE
Chapters 7, 8, and 9 provide additional information on some of the more widely known and widely recognized nursing frameworks and theories. To help the reader better understand the conceptual frameworks and grand theories of nursing, this chapter presents methods for categorizing or classifying them and describes the criteria that will be used to examine them in subsequent chapters.
CATEGORIZATION BASED ON NURSING DOMAINS
CATEGORIZATION BASED ON PARADIGMS
Entities (e.g., people) are seen as reducible, and change is seen as linear and causal. She noted that these theorists viewed reality as multidimensional, dependent on context (i.e., surrounding conditions) and relative.
BACKGROUND OF THE THEORIST
A full analysis of each theory was not performed; instead, the presentation of models and theories in Chapters 7, 8, and 9 is largely descriptive rather than analytical or evaluative. The criteria used to examine the grand theories in these three chapters are listed in Box 6-1.
PHILOSOPHICAL UNDERPINNINGS OF THE THEORY
Placing the author of the model or theory in a historical and conceptual perspective promotes the understanding of the existing views of science at the time in which the theorist wrote. Rogers's (1970) theory did not fit easily into the contemporary paradigm of nursing science at the time and was rejected by many in favor of a more intermediate thinking that corresponded to that of the postpositivist thinkers.
MAJOR ASSUMPTIONS, CONCEPTS, AND RELATIONSHIPS
Only in the most exceptional cases are scholars unlikely to be influenced by the time in which they formed their work. Interestingly, the discipline of nursing was deep in the positivist era in the 1960s when she began her work; and the hard sciences (ie, physics and chemistry) entered a post-positivist era that posited the idea that change was inherent to a growing discipline.
USEFULNESS
TESTABILITY
PARSIMONY
VALUE IN EXTENDING NURSING SCIENCE
Orem's nursing theory of self-care deficit: its philosophical foundation and the state of the science. Levine's model is placed early in the chapter because it is one of the earlier models.
PHILOSOPHIC UNDERPINNINGS OF THE THEORY
The language of the Intersystem Model is scientific English, and non-sexist language is used throughout. This intrasystem level of the model offers the nurse the opportunity to gradually develop a joint care plan with the client (Artinian, 1997a).
BACKGROUND OF THE THEORISTS
Adherents of the theory state that it is used in courses or in the curricula of various universities. Alison Tierney was one of the first nurses to obtain a PhD in the UK.
