The development of a theoryShu-Fang Vivienne WuAssistant professorNTUNHS

ObjectivesDefine theory and list characteristics of a theoryDescribe the components of a theory and its useTrace the development of a nursing theoryTheory Development in Nursing: Historical OverviewDescribe the different types of theories and examples of each.

Introduction to TheoryNursing as a profession There has been questions about whether nursing is a profession or an occupation. An occupation is a job a career.A profession is a learned vocation or occupation that has status of superiority and precedence within a division of work. It needs widely varying levels of training or education, skills and variable knowledge base. All professions are occupations but not all occupations are professions (Logan,Franzen, Butcher,2004;Schwiran , 1998)

Definitions of theory Defining theory is the first step towards developing a set of criteria for the evaluation of theory. Many of the early definitions of theory in the nursing literature were influenced by the Logical Positivistic Received View (Suppe, 1977), where the focus was on structure and process.Ex.1.McKay (1969) defines theory as a logically interrelated set of confirmed hypotheses (p. 394)and Jacox (1974) defines it as a systematically related set of statements including law-like generalizations that are empirically testable (p. 324). These definitions are consistent with the Received View philosophy on theory at the time.

Definitions of theoryChin and Jacobs (1983) define theory as a set of concepts, definitions, and propositions that projects a systematic view of phenomena by designating specific interrelationships among concepts for purposes of describing, explaining, predicting, and/or controlling phenomenon (p. 70). This definition begins a departure from the Logical Positivistic Received View, in that it does not emphasize the structure of the theory.

Problem in nursing:lack of agreement on the definition of theoryMany authors have used the term theory as interchangeable with such terms as conceptual framework, conceptual model, model, and paradigm. Fawcett (1989) clearly states that conceptual models and theories are clearly distinguished by their levels of abstraction and thus must be used in different ways .She defines nursing theory as a relatively specific and concrete set of concepts and propositions that purports to account for or characterize phenomena of interest to the discipline of nursing (p. 23).

A conceptual model vs. A theory A conceptual model is an abstract and general system of concepts and propositions.A theory deals with one or more relatively specific and concrete concepts and propositions(Dudley-Brown p.77) .

Distinguish a conceptual model from a theoryIf the purpose is to describe, explain, or predict specific phenomena, the work is most likely a theory. Ex. the works of Peplau (Alligood & Tomey Ch 5, p.54) and Orlando. If the purpose of the work is to articulate a body of distinct knowledge for the discipline of nursing, the work is most likely a conceptual model. Ex. the works of Johnson, King, Levine, Neuman, Orem, Rogers, and Roy.

Distinguish a conceptual model from a theoryMost of these theorists have been described by others as proposing a nursing theory, not a conceptual model. Failure to distinguish a conceptual model from a theory, Fawcett (1989) states, leads to misunderstandings and inappropriate expectations of the work. However, according to Meleis (1985), the use of different labels (theory, paradigm, model, and framework) corresponds to differences in emphasis rather than substance.

Definitions of theoryPinnel and Menesis (1986) Systematic set of interrelated concepts, definitions and deductions that describe, explain or predict interrelationships

Definitions of a theoryWalker and Avant (1983) Internally consistent group of relational statements (concepts, definitions and propositions) that presents a systematic view of phenomenon and which is useful for description, explanation, prediction and control

Definition of a theory Chinn and Krammer creative and vigorous structuring of ideas that project a tentative, purposeful and systematic view of phenomena

Definitions of a theoryMeleis,2005 Theory is an organized, coherent, and systematic articulation of a set of statements related to significant questions in a discipline that are communicated in a meaningful whole.

Some commonalitiesPurposeConceptsDefinitions PropositionsStructured ideasTentative Describe a phenomenon or occurrence

Components/Elements of theory1.Purpose Why is the theory formulated2.Concepts are building blocks of theory ideas, mental images of a phenomenon, an event or object that is derived from an individuals experience and perception

Components/Elements of theory3.Has a major concept like nursing, person, health or environment.

4. Definitions give meaning to concepts which can either be descriptive or procedural (stipulate-use of term within the theory)

Components/Elements of theoryPropositions are expressions of relational statements between and among the concepts. It can be expressed as statements, paradigms or figures . AKA as theoretical assertionsAssumptions- accepted truths that are basic and fundamental to the theory. Or value assumptions where what is good or right or ought to be.

Characteristics of a TheorySystematic, logical and coherent (orderly reasoning,no contradictions)Creative structuring of ideas mental images of ones experiences and create different ways of looking at a particular event or object.Tentative in nature ( change over time or evolving but some remain valid despite passage of time)

Theory Development

How does a theory develop?Four strategies of theory developmentTheory practice theory ( theory developed in other discipline and used in nursing situations)

2. Practice theory evolved from clinical practice

How does a theory develop?3. Research theory or inductive method Must evolve from research findings or empirical evidence.

4. Theory research theory theories developed by other disciplines are utilized but given unique nursing perspective. Original theory examined and given a new research findings.

TERMINOLOGYMETAPARADIGMMost abstract level of knowledge. In nursing this is main concepts that encompasses the subject matter and the scope of the disciplineCentral concepts of person, environment, health and nursing

TERMINOLOGYPhilosophyKnowledge level which specifies the definitions of the metaparadigm concepts in each of the conceptual models of nursing.Nightingale is considered philosophical approachOut of these philosophies theory maybe formalized

Conceptual modelsFrameworks or paradigms that provide a broad frame of reference for the systematic approaches to the phenomena with which the discipline is concerned.different views nursing like Roy focuses on adaptation, King on interaction and Abdellah on interventions

TheoryGroup of related concepts that propose actions that guide practice

Nursing theoryGroup of related concepts that derive tfrom the nursing models. Some derive from other nursing discipline like LEininger which comes from anthropologyNursing theory is defined as a conceptualization of some aspect of nursing reality communicated for the purpose of describing phenomena, explaining relationships between phenomena, predicting consequences, or prescribing nursing care(Meleis,2005).

Uses of theory1. Theory guides and improve nursing practice Theory provides goal for nursing care and with goals, nursing practice is rendered more effective and efficient.Theories help to focus the goals, making nurses more confident about the practice.

Uses of theory2. Theory guides research according to Meleis, primary use of theory is to guide research. It validates and modifies the theory.3. Theory contributes to the development of the disciplines body of knowledge4. Theory enhances communication

Theory Development in Nursing: Historical Overview

Where do I begin?Florence NightingaleConsidered first modern nursing theoristFirst one to delineate what is considered the nursing goal and practice domain. placing the client in the best condition for nature to act upon himTaught about symptoms and what they indicate, rationale for actions and trained powers of observation and reflection

Historical Development of Nursing Theories: Significant EventsNightingale until the 50sFlorence Nightingale Notes on Nursing control of the environment to care for the individual (ventilation, light, warm , noise absence or reduction, cleanliness & diet )

1952 Nursing Research Journal publication

1960s nature of nursing practice was debated, defined nursing practice, or develop nursing theory, and created a substantive body of knowledge

Historical development1960-1970 proliferation of conceptual models and frameworks, and philosophy of nursing. Examples: Abdellah 21 nursing problems and Halls Core, care and cure (person,body,disease)1969 first conference on nursing theory

Historical DevelopmentRole of nurses where questioned; what they do, for whom where and when were determined.purpose of nursing, process of theory development was discussed

Historical Development1980s characterized by acceptance of the significance of theory in nursing. Less debates on whether or not to use theory, practice theory or borrowed ones. More and more publication up to the present.

Types of theoriesAccording to rangeGrand theory Middle range theoryMicro theory

Types of theories: Grand Theory Grand Theory consist of broad conceptual frameworks that reflect wide and expansive perspectives for practice and ways of describing, explaining, predicting and looking at nursing phenomena. They are the most complex and broadest in scope.Ex. Hendersons The Nature of Nursing ; Levines The Four Conservation Principles of Nursing, Roys Adaptation Model, and Orems Self-Care (Marriner-Tomey)

Types of Theories: Mid Range- Mid Range- less complex and narrower in scope than grand theory and micro theory. A more workable level is the middle range.more limited in scope and less variables, and testable.grand theory on stress and adaptation might not yield any interpretable guidelines on practice but if the theory is focused on chronic lingering illness as the stressor on family, the stress theory becomes operational for both research and practice purposes.Ex. Peplaus Psychodynamic Nursing and Orlandos Nursing Process Theory

Types of theories: Micro theoriesMicro theories- are the least complex. They contain the least complex concepts and are narrowest in scope. They deal with a small aspect of reality, generally a set of theoretical statements Deals with specific and narrow defined phenomena

According to Orientation or focus of the theoryClient centered: Nightingale, HendersonClient-nurse dynamics: WatsonClient-nurse environment : Leininger

Categories of nursing theoriesclient`nurseenvironment

Client centered theoryFocused on the needs and problems of clients which are met, resolved or alleviated by nursing interventionsThis category includes theories developed by the following : Nightingale,Abdellah,Henderson,Orem,Pender, Roy, Levine, Hall.

Nurse client dynamicsFocus on interaction between the nurse and client. This category includes theories developed by the following: Peplau, Watson, King and Orlando

Client Nurse Environment DynamicsFocus on the interaction between nurse and client in an environment that includes broader dimensions of time and space.As well as culture, cultural diversity, and universality. Theories of Neuman and Leininger are discussed under this category.

Framework to Analyze the Nursing theory1.What are the major concepts? Person, nursing, health and environment2. Based on Focus Client centered, nurse-client dynamics, nurse client-environment dynamics -How similar and how different are their concepts of persons, nursing, health, environment3. Key concepts unique to the theory. Some theories have several key concepts and it may have sub-concepts.

Analysis of theoryClarityHow clear is this theory?SimplicityHow simple is this theory?GeneralityHow general is this theory?Empirical precision How accessible is this theory?Derivable consequences How important is this theory?

ConclusionTheory development and evaluation are cyclical, continuous, and dynamic process. One can not exist without the other.Theory evaluation including description, concept analysis, theory critique, testing and support.These process are based on the view that science is a human process that includes not only valid findings but also observation, agreements, useful solutions to problems.Theory evaluation is central to the development of theory; it is the responsibility of each clinician, academician.

ExercisePlease see the attachment: Adaptation model of nursing1.Define theory and list characteristics of a theory2.Describe the components of a theory and its use3.Trace the development of a nursing theory4.Theory Development in Nursing: Historical Overview

3. Major concepts may not be present in the theory but a main concept is usually presnt and the author is usuallyKnown for that example Orems Self Care TheoryTheories used using the practice theory strategy evolved from clinical practice. Example Orlandos nursing process theory

Grand Theory consist of broad conceptual frameworks that reflect wide and expansive perspectives for practice and ways of describing, explaining, predicting and looking at nursing phenomena. They are the most complex and broadest in scope. Hendersons The Nature of Nursing ; Levines The Four Conservation Principles of Nursing, Roys Adaptation Model, and Orems Self-Care (Marriner-Tomey)Mid Range- less complex and narrower in scope than grand theory and micro theory. A more workable level is the middle range.more limited in scope and less variables, and testable.Example: grand theory on stress and adaptation might not yield any interpretable guidelines on practice but if the theory is focused on chronic lingering illness as the stressor on family, the stress theory becomes becomes operational for both research and practice purposes. Ex. Peplaus Psychodynamic Nursing and Orlandos Nursing Process TheoryMicro theories- are the least complex. They contain the least complex concepts and are narrowest in scope. They deal with a small aspect of reality, generally a set of theoretical statements- Deals with with specific and naroow defined phenomena. This category includes theories developed by the following : Nightingale,Abdellah,Henderson,Orem,Pender, Roy, Levine, Hall.Nurse-client-dynamics focus on interaction between the nurse and client. This category includes theories developed by the following: Peplau, Watson, King and OrlandoCLIENT NURSE ENVIRONMENT- focus on the interaction between nurse and client in an environment that includes broader dimensions of time and space. As well as culture, cultural diversity, and universality. Theories of Neuman and Leininger are discussed under this category.