Susan S. Gunby, RN, PhD Fall Semester 2003 USING NURSING THEORIES AS FRAMEWORKS FOR PRACTICE, EDUCATION, & RESEARCH Susan S. Gunby, RN, PhD Fall Semester 2003

-- Leah Curtin, RN, MS, FAAN (1989) Former Editor, Nursing Management “Practicing nurses who despise theory are condemned to performing a series of tasks – either at the command of a physician or in response to routines and policies.” -- Leah Curtin, RN, MS, FAAN (1989) Former Editor, Nursing Management

“Theory internalizes principles which increase adaptability and flexibility and enables one to transfer experience from one situation to the next.” -- Leah Curtin

“ . . . the truth thus ascertained would enable us to save life and suffering, and to improve the treatment and management of the sick . . . .” -- Florence Nightingale Proposal presented to the International Statistical Congress in London, 1860

“All must go at the end of 2 months, except those who are dying “All must go at the end of 2 months, except those who are dying.” - Florence Nightingale (1854)

Nursing Praxis is: * Informed action (simultaneously the action and the knowledge that inform it). (Carr & Kemmis, 1986) Reflection upon practice toward the refinement of theory and therefore the enhancement of practice. (Thorne & Hayes, 1997) *

Discipline of Nursing Must Examine: What it means to practice nursing. What knowledge is held as “private” vs. “public.” What ideals are embedded in nursing practice as well as in the generation of nursing knowledge. (Kim, 2000)

Barbara A. Carper (1978): “It is the general conception of any field of inquiry that ultimately determines the kind of knowledge that field aims to develop as well as the manner in which that knowledge is to be organized, tested, and applied . . . .”

Barbara A. Carper (1978): “Such an understanding . . . involves critical attention to the question of what it means to know and what kinds of knowledge are held to be of most value in the discipline of nursing.”

WAYS OF KNOWING or FORMS OF KNOWLEDGE Empirical Ethical Personal Esthetic

COMPONENTS & LEVEL OF ABSTRACTIONS Metaparadigm Most Abstract Philosophies Conceptual Models Theories Most Concrete Empirical Indicators

Global concepts that identify the phenomena of interest METAPARADIGM Global concepts that identify the phenomena of interest

Global propositions that state the relationships among those phenomena METAPARADIGM Global propositions that state the relationships among those phenomena

METAPARADIGM . . . an encapsulating unit, or framework, within which the more restricted. . .structures develop.” (Eckberg & Hill, 1979, p. 927)

boundary on the subject matter of METAPARADIGM The functions of a metaparadigm are to summarize the intellectual and social missions of a discipline and place a boundary on the subject matter of that discipline. (Kim, 1989)

PHENOMENA OF INTEREST TO NURSING REPRESENTED BY FOUR CENTRAL CONCEPTS 1. Person 2. Environment 3. Health 4. Nursing

PHILOSOPHIES Are Statements About: *** What people assume to be true in relation to the phenomena of interest to a discipline. (Christensen & Kenney, 1990) *** What people believe regarding the development of knowledge about those phenomena.

EXAMPLE OF PHILOSOPHICAL STATEMENT “The individual . . . behaves purposefully, not in a sequence of cause and effect.” (Roy, 1988, p. 32)

CONCEPT An abstract idea or mental image of phenomena or reality.

CONCEPTS Abstract ideas that give meaning to our perceptions Permit generalizations Stored in memory for recall & use at later time in a new & different situation.

CONCEPTS May be linked together to explain approaches to nursing care and to predict the outcome of care.

Concepts When operationalized, become variables used in hypotheses to be tested in research. Explicate subject matter of theories of a discipline.

CONCEPTUAL MODELS A set of abstract and general concepts and propositions that integrate those concepts into a meaningful configuration. (Lippitt, 1973; Nye & Berardo, 1981)

Provide a distinctive frame of reference. CONCEPTUAL MODELS Provide a distinctive frame of reference.

EXAMPLES OF CONCEPTUAL MODELS *** King’s General Systems Framework *** Roy’s Adaptation Model

THEORIES Consist of relatively specific and concrete concepts and propositions that purport to account for or organize some phenomenon. (Barnum, 1994)

THEORIES Vary in the relative level of concreteness and specificity of their concepts and propositions.

THEORIES Primary Purpose: To generate knowledge.

THEORIES Provide a communication system in terms of a set of concepts that are interrelated and understandable to others.

Enable nurses to know WHY they are doing WHAT they are doing. THEORIES Enable nurses to know WHY they are doing WHAT they are doing.

THEORIES Provide knowledge to improve practice & education by describing, explaining, predicting, controlling, and understanding phenomena.

THEORIES Help develop analytical skills, challenge thinking, clarify values and assumptions, and determine purposes for nursing practice, education, and research.

THEORIES Enhance professional autonomy by guiding the practice, education, and research functions of the profession.

EMPIRICAL INDICATORS The actual instruments, experimental conditions, and research methodologies used to observe or measure the concepts of a middle-range theory.

Theory, Education, Research, Relationship(s) Theory, Education, Research, of and Practice

Summary

Thank you!