Chapter 2 Overview of Theory in Nursing

Theory It is the unique theories and perspectives used by a discipline that distinguishes it from other disciplines. Theories of a discipline Clarify basic assumptions and values Define the nature and purpose of practice

Theory—Definitions A systematic explanation of an event in which constructs and concepts are identified and relationships are proposed and predictions made A system of interrelated propositions used to predict, explain, understand, and control a part of the empirical world

Theories Are composed of concepts, propositions, and laws; they can be communicated Vary according to the number of elements, characteristics and complexity of the elements, and type of relationships among the elements Are invented rather than discovered

Question “A tentative suggestion that a specific relationship exists between two concepts or propositions” is a definition of: Assumptions Epistemology Hypothesis Ontology

Answer C. Hypothesis Rationale: A hypothesis is a tentative suggestion that a specific relationship exists between two concepts or propositions.

An Example of “Theory” “Well, ya see Normmy, it’s like this . . . a herd of buffalo can only move as fast as the slowest buffalo. And when the herd is hunted, it is the slowest and weakest ones at the back that are killed first. This natural selection is good for the herd as a whole, because the general speed and health of the whole group keeps improving by the regular killing of the weakest members. In much the same way, the human brain can only operate as fast as the slowest brain cells. Excessive intake of alcohol, as we all know, kills brain cells, but naturally it attacks the slowest and weakest brain cells first. In this way, regular consumption of beer eliminates the weaker brain cells, making the brain a faster and more efficient machine. That’s why you always feel smarter after a few beers.” —Cliff Claven (Cheers)

Theory in Nursing Theory provides structure and organization for nursing knowledge. Theory provides systematic means of collecting data to describe, explain, and predict phenomena of importance to nursing. Theories define and clarify nursing and distinguish it from other caring professions.

Uses of Theory in Nursing Identify standards of practice Identify settings for practice Identify distinctive nursing processes to be used Direct the delivery of nursing interventions Serve as the basis for clinical information systems Direct quality improvement programs

Terms Used in Theory Assumptions—beliefs about phenomena that are accepted as true Concept—abstract elements of a phenomenon necessary to understand it Construct—complex concepts; comprises more than one concept and built or “constructed” to fit a purpose

Terms Used in Theory—(cont.) Empirical indicator—specific and concrete identifiers of concepts; method used to observe or measure the concept(s) Hypotheses—tentative suggestions that a specific relationship exists between two concepts or propositions

Terms Used in Theory—(cont.) Model—graphic or symbolic representation of a phenomenon Paradigm—organizing framework that contains concepts, theories, assumptions, beliefs, values, and principles that form the way a discipline interprets the subject matter with which it is concerned

Terms Used in Theory—(cont.) Philosophy—a statement of beliefs and values about human beings and their world Relationship statements—indicate specific relationships between two or more concepts; may be propositions, hypotheses, laws, or theorems

Stages of Theory Development in Nursing Silent knowledge Received knowledge Subjective knowledge Procedural knowledge Constructed knowledge Integrated knowledge

Stages of Theory Development in Nursing—(cont.) Silent knowledge stage (1870s–1940s) Nurses were trained in hospitals. Education was controlled by the hospital and doctors. Education and practice were based on tradition, rules, and principles and focused on technical skills. Apprentice form of education

Question Tell whether the following statement is true or false: In the “silent knowledge” stage, emphasis on nursing education grew following publication of the report Nursing for the Future by Esther Brown.

Answer False Rationale: Esther Brown’s report was part of the “received knowledge” stage. The silent knowledge stage applies to the very early years of nursing education.

Stages of Theory Development in Nursing—(cont.) Received knowledge stage (1945–1960) Serious nursing shortage Hill-Burton Act increased the need for nurses. Nursing for the Future published—promoted nursing education in universities

Stages of Theory Development in Nursing—(cont.) Received knowledge stage (1945–1960)—(cont.) Testing for registration began. Nursing Research first published Books on nursing research and theory were published. Slow growth of graduate education—nurses questioning practice

Stages of Theory Development in Nursing—(cont.) Subjective knowledge stage (1960–1970) Dickoff et al. published articles on theory development and theory for a practice discipline. Number of nursing theorists grew.

Stages of Theory Development in Nursing—(cont.) Procedural knowledge stage (1970–1985) Nursing viewed as an academic discipline Theories became the framework for nursing education. More nursing theories were published.

Stages of Theory Development in Nursing—(cont.) Procedural knowledge stage (1970–1985)—(cont.) Consensus developed regarding the common elements of nursing Person or client (man) Health Nursing Environment

Stages of Theory Development in Nursing—(cont.) Procedural knowledge stage (1970–1985)—(cont.) Books published on Theory evaluation/critique Theory application Theory construction Graduate courses on nursing theory implemented

Stages of Theory Development in Nursing—(cont.) Constructed knowledge stage (1985–2010+) Incorporation of philosophy of science courses into graduate programs Development of middle range and practice theories

Stages of Theory Development in Nursing—(cont.) Integrated knowledge stage (2010–???) Increasing focus on “evidence-based practice” Continued development of middle range and situation-specific theories Attention to “translation” of research in practice

Scope of Theory Metatheory Grand theory Middle range theory Practice theory

Scope of theory—(cont.) Metatheory—theory about theory In nursing, metatheory focuses on broad issues. Philosophical issues Philosophical worldviews (perceived view vs. received view) Nature of health and man; purpose of nursing Appropriate level of nursing theory Methodological issues Processes of theory evaluation Processes of knowledge development

Scope of Theory—(cont.) Grand theories Most complex and broad theories Attempt to explain broad areas within a discipline Characteristics Nonspecific Composed of relatively abstract concepts and propositions Are not generally amenable to testing May incorporate other theories

Scope of Theory—(cont.) Middle range theories More circumscribed than grand theories Contain a limited number of concepts that are operationally defined Focus on a limited aspect of reality Propositions may be tested through research.

Scope of Theory—(cont.) Middle range theory may be: A description of a particular phenomenon An explanation of the relationship between phenomena Prediction of the effects of one phenomenon or another

Scope of Theory—(cont.) Practice theories Called microtheories, prescriptive theories, situation- specific theories Least complex; contain fewest concepts Refer to specific, easily defined phenomena Limited to specific populations or fields of practice Often use knowledge from other disciplines

Comparison of the scope of nursing theories.

Types of Theory Descriptive theory Explanatory theory Predictive theory Prescriptive theory

Descriptive Theories Describe, observe, and name concepts Do not explain how or why concepts are related Provide observation and meaning regarding phenomena Generated and tested through descriptive research

Explanatory Theories Relate concepts or propositions to one another Attempt to explain how or why concepts are related Focus on correlations or rules that regulate interactions Developed through correlational research

Predictive Theories Explicate conditions under which concepts are related and relational statements are able to describe future outcomes consistently Experimental research is used to generate and test them.

Prescriptive Theories Prescribe activities necessary to reach defined goals Address actions and predict consequences of interventions Describe the prescription (action or intervention), consequence, type of client, and condition

Nursing’s Metaparadigm Metaparadigm—the most global perspective of a discipline The primary phenomena that are of interest to a discipline Explains how the discipline deals with phenomena in a unique manner

Nursing’s Metaparadigm—(cont.) Characteristics of a metaparadigm Domain is distinctive from other disciplines. Encompass all phenomena of interest to the discipline Are perspective-neutral (concepts and propositions do not represent a specific perspective or worldview) Must be international in scope and substance (do not reflect national, cultural, or ethnic beliefs and values)

Nursing’s Metaparadigm—(cont.) Most scholars and theorists consider that nursing’s metaparadigm consists of the concepts of: Person (man or client) Health Environment Nursing Some scholars/theories add “caring.”

Nursing’s Metaparadigm—(cont.) Person can refer to a(n): Being consisting of physical, intellectual, biochemical and psychosocial needs Human energy field Holistic being Open system Integrated whole Being who is greater than the sum of his parts

Nursing’s Metaparadigm—(cont.) Health The ability to function independently Successful adaptation to life’s stressors Achievement of one’s full life potential Unity of mind, body, and soul Health is the concept reflecting greatest diversity in nursing theory.

Nursing’s Metaparadigm (Continued) Environment refers to: External elements that affect the person Internal and external conditions that influence the organism Significant others with whom the person interacts An open system with boundaries that permit the exchange of matter, energy, and information

Nursing’s Metaparadigm—(cont.) Nursing is a science, art, and practice discipline. Goals of nursing include: Care of the well Care of the sick Assisting with self-care Helping individuals attain their human potential

Question Which of the following is not considered to be one of the major concepts of nursing’s metaparadigm? Environment Health Nursing Person/recipient of care Professionalism

Answer E. Professionalism Rationale: The other four concepts are considered to be concepts of the nursing metaparadigm.