1. Trends & Methods in the Education of Nursing Theory
Hesook Suzie Kim, PhD, RN
Professor Emerita
College of Nursing University of Rhode Island;
Project Director of Research Programs
Buskerud University College, Norway

2. The Nature of Nursing Theory
Nursing Theory as the Theoretical Base for Nursing Practice
Theory of Nursing
Theories developed for specialized phenomena of nursing
Theory in Nursing
Theories developed for phenomena that are relevant in the nursing context, requiring translation, transfer, or reconstruction from the nursing perspective
Theory VS Theoretical Knowledge
“Theory” too specific
“Theoretical knowledge” to embrace sets of various forms and types of theoretical statements/ideas

3. Types of Nursing Theory (Theoretical Knowledge in Nursing)
Concepts
Theories
Grand
Meso
Middle Range
Micro
Models
Conceptual Frameworks
Theoretical Frameworks
Metatheory

4. The Historical Path
Four Phases of Nursing Knowledge Development as a Scientific Discipline
The Declaration of Independence Phase
The Formative Phase
The Reformatory Phase
The Diversifying Phase

5. The Declaration of Independence Phase (1950s~1960s)
Forces
Separation from Medicine
Need to specify the unique features of nursing as a discipline
Nursing’s place in the academia
Defining the Specific Nature of Nursing Knowledge
Focus on the relationship between nurse and patient as the unique aspect
Focus on the patient’s problems to which nurse must attend
Developments in Nursing Theory
Interaction theories (Peplau, Orlando, Travelbee, Wiedenbach)
Problem frameworks (Henderson & Harmer, Abdellah, Levin)
Other Discourses
Scientization of nursing
Concepts of scientific theory development

6. The Formative Phase (1970s~ Early part of 1980s)
Conceptual & Theoretical Frameworks of Nursing
Rogers (The Science of Unitary Humans)
Orem (Self Care model)
Roy (Adaptation Model)
Neuman (Systems Model)
King (Theory of Goal Attainment)
Watson (Theory of Human Care)
Parse (Human Becoming Theory)
Labeling Issue
Conceptual Model, Theoretical Model, & Grand Theory
Translation & Adoption of Theories from Other Disciplines (Theories in Nursing Development)
Biophysiology
Psychology
Social Sciences (Sociology, Anthropology, & Management)
Empirical Research to Develop Theories
Women’s Health
Dying
Infant Development

7. The Reformative Phase (Mid 1980s to the end of 1990s)
Emergence of Multiple Philosophical and Paradigmatic Approaches to Nursing Knowledge Development
Epistemology
Movement from Positivism to Post-positivism & Relativism
Awakening to Post-modern Philosophies
Methods
Positivistic methods to Interpretivists’ Approaches
Paradigms
Movement from the Systems Paradigm to Holistic Paradigm
Concept and Middle Range Theory Development
Concept Developments Adopting Various Methods
Middle Range Theory Development
Theories for Nursing Therapeutics
Development of theory-based interventions focusing on specific client problems

8. The Diversifying Phase (2000 to Present)
New Issues
Theories from the global versus local perspective
New debates on the nature of nursing (Science VS Art)
The Philosophy of Evidence-Based Practice
The lack of unification regarding the nature of nursing epistemology
Discourse on the big picture missing
Continuation of the Pluralistic Mode
Concept development
Middle Range Theory Development
Nursing Therapeutics Theories
The growing accumulation of knowledge from the interpretive, critical, and post-modern philosophies -- No effort for consolidation, interconnections, or mapping

9. Current Status of Theoretical Knowledge in Nursing
Types of Knowledge
Generalized
Situated Hermeneutic
Critical Hermeneutic
Ethical
Aesthetic
Content Areas of Knowledge
According to the Domains
Client Domain
Client-Nurse Domain
Practice Domain
Environment Domain
According to Specialized Fields
General Nursing
Specialty Areas

10. Theory, Research, & Practice

11. Use of Theory in Research & Practice
The Declaration of Independence Phase
Theory in Practice
As an ideology
Theory in Research
Minimal empirical research
The Formative Phase
As a framework for assessment
Empirical research based on theories from other disciplines
The Reformative Phase
Unsystematic & ad hoc applications
Development & testing of middle-range theories
The Diversifying Phase
EBP movement
Continued development and testing of MRT

12. Changes in Nursing Theory Education - The Graduate Level
Master’s Education
Changes
1970s - Focus on Conceptual Models
1980s - Continuing focus on Conceptual Models
1990~ Concepts, Conceptual/Theoretical Models, Theories
2001~Present - Theories specific to clinical specialty areas for the relevance to practice
Forces
Changes in the concentration areas in the MS
Changes in the Guidelines (AACN)
1996 Essentials: “Critique and evaluate a variety of theories from nursing and related fields, & apply and utilize appropriate theories from nursing and related fields to provide high quality health care to clients;”
2011 Essentials: “Develop a deeper understanding of nursing and the related sciences needed to fully analyze, design, implement, and evaluate nursing care”

13. Research-focused Doctoral Programs
Position Paper (2010)
Developing the Science
History and philosophies of science
Scientific methods, including team science
Advanced research design and statistical methods
Research ethics
Data, information and knowledge management, processing and analysis
Ways of knowing and habits of the mind
Stewardship of Discipline
Theoretical/scientific underpinnings of nursing and other disciplines
Quality Indicators (2001)
Historical and philosophical foundations to the development of nursing knowledge;
Existing and evolving substantive nursing knowledge;
Methods and processes of theory/knowledge development;
Research methods and scholarship appropriate to inquiry; and
Development related to roles in academic, research, practice, or policy environments.

14. Practice-focused Doctoral Education (DNP)
New development (AACN Position paper in 2004)
As an educational preparation for Advanced Nursing Practice (MS programs to be phased in by 2015)
A terminal practice degree in nursing
Currently in the US – 120+ DNP programs
Program
Less emphasis on theory & meta-theory
Direct-patient care focus with advanced practice in a specialty area
Organizational/systems Leadership
Aggregate/Population Emphasis
Requirements for Theoretical Knowledge within the Curriculum (From the “Essentials of DNP in APN)
The conceptual foundation of nursing science and its advances
The natural & social sciences as the scientific foundation of nursing practice (Human biology, genomics, the science of therapeutics, the psychosocial sciences, the science of complex organizational structures)
Philosophical, ethical, & historical issues in the development of science
Nursing science framed with middle range theories and concepts

15. Theory Courses in Selected Schools (A Survey of 30 schools)
Master’s Programs
No general theory course (9 schools)
Theories from nursing and other sciences within the specialty courses
General Theoretical Foundations of Nursing (10 schools)
Concept & concept development
Survey and analysis of nursing theories
Theoretical & conceptual thinking
Theoretical Foundations of APN (10)
Theoretical foundations of APN
Philosophical, theoretical, & ethical foundations of APN
Nursing Theory in relation to Research & Practice (1)
Theory, research, & practice for EBP
DNP Programs
General theory course (Foundations of Nursing Science)
Theoretical/scientific foundations for APN
Survey of specific theories
Specific theory development methods for APN

16. PhD Programs Philosophy of Science & Nursing Science Development
Philosophical foundations
Theories of science
Conceptual & Theoretical Foundations of Nursing Science
Survey, analysis, & evaluation of existing theories
Theory Development
Theory construction
Theory processes & outcomes
Concept analysis & development
Knowledge development
Middle-range theory development
Science of nursing therapeutics
Knowledge synthesis
Synthesis & Application

17. Thoughts on Future Directions
Content
Progress & status of nursing theory development
Genealogical survey of nursing knowledge & its development
Nursing knowledge development in the context of the philosophy of science
Delineation of theories relevant for general nursing practice and for specialized practice
Theory analysis, critique, and evaluation
Theory development approaches and strategies for expanding knowledge
Theory synthesis for Practice

18. The Structure of Content
Knowledge
Developed
Through
The ages
Currently
Relevant
Stock of
Knowledge
Newly
Developing
Knowledge
SURVEY
ANALYSIS
CRITIQUE & EVALUATION
CODIFICATION
IDENTIFICATION OF AREAS FOR DEVELOPMENT
KNOWLEDGE DEVELOPMENT STRATEGIES

19. Content Delineation for Different Levels
General Knowledge
KNOWLEDGE
TYPE
Specialty Knowledge
MS Level
Survey
Analysis
EPISTEMIC
ENGAGEMENT
Codification
Evaluation
Production
Description
Systematization
PhD Level
DEPTH
Compare & Contrast
Larger Picture
Knowledge synthesis
Practice models
KNOWLEDGE
DEVELOPMENT
Concept Development
Theory development
Primary
Paradigm Development
Secondary

20. Curriculum Development for Nursing theory Contents
Relationship Between MS & PhD Levels
The merging of MS & DNP (At least in the US)
MS (& DNP) education as the foundation for the PhD level
Differentiation of MS from PhD
MS & DNP
Focus on the knowledge of nursing theory relevant for advanced nursing practice (Use-oriented)
theory review & analysis
theory use
PhD
Focus on the knowledge of nursing theory for shaping the disciplinary knowledge base of nursing (Development-oriented)
Building a comprehensive view of the disciplinary knowledge
Codification of knowledge development
Theory critique
Theory development

21. Curriculum Development for Nursing theory Contents
Content Organization for Courses
Two Types of Theory Content
Substantive knowledge (“WHAT”)
MS (DNP) Level – Survey & analysis of established general & specialty knowledge
PhD Level – Survey, analysis, critique of established & developing general knowledge, & critique of developing knowledge of a specified area
Strategic knowledge (“HOW”) – Survey; Analysis; Codification; Evaluation/Critique; & Production
Teaching Methods
Engagement in knowledge development strategies during the courses (concept analysis, concept development, middle-range theory development, etc.)
Student participation
Tailoring of requirements to students’ specialty areas and areas of interest

22. Curriculum Development
The Guiding Principle – The objective(s) of the curricular component related to theory
MS (DNP)
Critical analysis of theory and its use for advanced nursing practice
PhD
Synthesis of theory development & application of theory development strategies for advancing nursing knowledge in general and in a particular field of study

23. Content for Knowledge Types
General Knowledge
Specialized Knowledge
General concepts in nursing
Client Domain (e.g., health, illness, dying, chronicity, disability, adaptation)
Client-Nurse Domain (e.g., interaction, communication, collaboration, negotiation)
Practice Domain (e.g., clinical decision making, assessment, therapeutics, nursing gaze)
Environment Domain (e.g., health care environment)
General Nursing Theories
General theories of nursing care & therapeutics
Grand theories
Paradigms of the Discipline
Metatheory
General knowledge regarding the discipline of nursing
Historical development
Structure of the discipline
Social & cultural frames for the discipline
Knowledge Specific to Specialty Areas
Specialty-specific Client Problems
Specialty-specific Care Strategies & Therapeutics
Specialty practice dynamics
Specialty practice environment
Specialty-specific policies & laws (Role requirements)
Knowledge specific to an area of interest
Knowledge of specific concepts/phenomena
Knowledge of specific theories
Knowledge of specific paradigm or framework

24. An Illustration of the Contents related to theory – The USA case
The Essentials of MS education in nursing (2011)
Essential I: Background for Practice from Sciences and Humanities
Advanced nursing science, including the major streams of nursing scientific development
Scientific bases of illness prevention, health promotion, and wellness
Nursing Theories
The Essentials of DNP education in nursing (2006)
Essential I: Scientific underpinnings for practice
Integration of nursing science with knowledge from other relevant areas of knowledge
Science-based theories and concepts for assessment, intervention, & evaluation in patient care
Development of new practice approaches based on nursing theories & theories from other disciplines
Position on PhD education in Nursing (2010)
Develop Science
History & philosophies of science
Scientific methods; Ways of Knowing and Habits of the Mind
Scientific depth in the area of study
Steward the Discipline
Theoretical/Scientific underpinnings of nursing & other disciplines

25. Knowledge Type as the Anchor
Dimension
General Knowledge
Specialized Knowledge
MS (DNP)
PhD
Survey
Analysis
Codification
Evaluation
Production
Description
Systematization
Compare & Contrast
Larger Picture
Knowledge Synthesis
Practice Model
Concept Development
Theory Development
Paradigm Development
Engagement
Epistemic
Depth
Knowledge
Development

26. Mapping of the Matrix Standardization across programs
Objectives
Contents
Allowances for a degree of openness for creative curricular designs
Courses & sequences
Separate courses versus integrated courses
Different levels of courses
Teaching & learning methods
A degree of immersion by students
A degree of personal experience in theory survey, analysis, critique, & development

27. Discussions