1. 3/28/20181

2. Nursing Theories and Frameworks By Dr. Angela Gnanadurai Vice Principal CSI College of Nursing Dr. SM CSI Medical College Hospital Karakkonam

3. 3/28/20183 Learning Objectives ► Compare inductive and deductive reasoning ► Differentiate between conceptual and theoretical frameworks ► Describe how a framework guides research ► Differentiate between conceptual and operational definitions ► Describe the relationship between research and theory and practice

4. 3/28/20184 Learning Objectives ► Differentiate between grand and midrange nursing theories ► Describe the criteria for critique of theoretical or conceptual frameworks in the nursing literature and research

5. 3/28/20185 Approaches to Science ► Inductive Reasoning ► Deductive Reasoning

6. 3/28/20186 Deductive Theoretical Approach Seek to use existing theory to shape the approach which you adopt to the qualitative research process and to aspects of data analysis : Analytical Procedures ► Pattern Matching : Involves predicting a pattern of outcomes based on theoretical propositions to explain what you expect to find ► Explanation Building : Involves attempting to build an explanation while collecting and analysing the data, rather than testing a predicted explanation as in pattern matching

7. 3/28/20187 Inductive Approach Seek to build up a theory which is adequately grounded in a number of relevant cases. Referred to as Interpretative and Grounded Theory Art of Interpretation ► Field Text: Consists of field notes and documents from the field ► Research Text: Notes and interpretations based on the filed text ► Working interpretative document: Writers initial attempt to make sense out of what he has learned ► Public Text: The final tale of the Field

8. 3/28/20188 Ladder of Abstraction ► Worldview ► Frameworks ► Theories ► Concepts ► Variables

9. 3/28/20189 World view & Frame work ► World view-Holistic ► Frame work of nursing theory I. Theory: group of concepts that describes a pattern of reality It can be tested, changed or used to guide research II. Concepts: abstract impressions organized into symbols of reality Conceptual frame work or model

10. 3/28/201810 Concept ► Definition:  an abstraction  creates an image of an idea we want to share  representations of particular aspects of human behavior and characteristics ► Pain ► Coping ► Grief ► Resilience

11. 3/28/201811 4 Common Concepts ► Nursing ► Person ► Health ► Environment

12. 3/28/201812 Identify the Concepts ► “A theoretical model was developed and tested to explain the effects of learned helplessness, self-esteem, and depression on the health practices of homeless women.” (Flynn, 1997) ► “…prevalence and consequences of verbal abuse of staff nurses by physicians were examined in the context of Lazarus’ stress-coping model.” (Manderino & Berkey, 1997)

13. 3/28/201813 Construct ► Similar to a concept in that it refers to an abstraction ► Different from a concept in that it is deliberately invented (constructed) by researchers for a scientific purpose  Health focus of control  Self-care in Orem’s model ► “Concept” and “construct” are sometimes used interchangeably although a construct often refers to a more complex abstraction than a concept

14. 3/28/201814 Theory development ► Description ► Explanation ► Prediction ► Prescription

15. 3/28/201815 Terminology ► Conceptual framework:  Structure of concepts and theories pulled together like a map for the study ► Theoretical framework:  A structure of concepts that exists in the literature, a ready-made map for the study  Provide a theoretical rationale for the development of hypotheses

16. 3/28/201816 Conceptual Framework ► Explains how the variables in your study are expected to relate to each other ► A conceptual framework is used when the literature does not contain a specific theory that explains the relationship between study variables.

17. 3/28/201817 Theoretical Framework ► Used when the variables have been studied before and have been found to be related to one another ► At Level I there may be no framework based on existing literature. This establishes a rationale for the need to conduct such a study. ► At Level II you can provide a conceptual framework from literature on the variables of your study. ► Level III studies always have theoretical frameworks.

18. 3/28/201818 4 pillars of Frame work ► Theoretical knowledge of research ► Scientific writing ► Psychological support ► Experimental learning

19. 3/28/201819 Theoretical knowledge ► How much? ► Application of principles ► 11 decision model

20. 3/28/201820 Scientific writing ► Style of writing ► English is second language ► Scientific writing is a skill

21. 3/28/201821 Psychological support ► Most crucial of 4 pillars ► Address insecurity, negative attitude ► Have open door policy ► Be a role model to be a researcher

22. 3/28/201822 Experimental learning ► Without doing research and becoming experienced, one cannot overcome negativity about research ► Accomplish specific outcomes

23. 3/28/201823 What does a framework do? ► Provides direction for the study by providing an organized set of ideas/variables and their relationships ► Reveals conceptual and operational definitions ► Guides what data is to be collected and analyzed

24. 3/28/201824 Goals of frame work ► Holistic patient care ► Individualized care to meet needs of patients ► Promotion of health ► Prevention or treatment of illness

25. 3/28/201825 Terminology ► Conceptual definition – like a dictionary definition; conveys the general meaning of a concept ► Operational definition – specifies how the concept will be measured (i.e., what instruments will be used)

26. 3/28/201826 Appendix B – Van Cleve et al., 2004 Concept Conceptual definition Variable Operational definition Pain experience Symptom experience Pain Poker chip tool, body outline, pain tool Pain mgmt. Perception of mgmt. effectiveness Pain response Functional status II

27. 3/28/201827 Terminology ► Theory – set of interrelated concepts that provides a systematic view of a phenomenon  OR: Theory is an abstract generalization that presents a systematic explanation about the relationships among phenomena ► “Theory guides practice and research; practice enables testing of theory and generates questions for research; research contributes to theory-building and establishing practice guidelines.” LB-W & H p. 113

28. 3/28/201828 Nursing Theory ► Many theory/concepts “Borrowed” from other disciplines ► Nursing Theories:  Grand  Mid-range  Microrange

29. 3/28/201829 Nursing Theories ► Conceptual structure that organizes practice and research into ideas central to the discipline ► “Nursing theories are reservoirs in which findings related to nursing concepts, such as comfort, healing, recovering, mobility, rest, caring, enabling, fatigue, and family care, are stored.” Meleis (1997)

30. 3/28/201830 Grand Theories ► Conceptual structures that include views on person, health, and environment to create a perspective of nursing  Historically important  Guides discipline of nursing today  Abstract level  Address a phenomena of concern to nursing from a different perspective

31. 3/28/201831 Grand Theories ► Imogene King, 1981 – Open Systems Model ► Madeleine Leininger, 1991 – Theory of culture care diversity and universality ► Dorothea Orem, 1985 – Self-care Model ► Sr. Callista Roy, 1984, 1991 – Adaptation Model ► Jean Watson, 1999 – Theory of Caring ► These models are broad, formal explanations of what nursing discipline is according to the developer’s point of view

32. 3/28/201832 Midrange Theories ► Are moderately abstract but composed of concepts that are measurable ► More focused than grand theories ► Have a stronger relationship with research and practice ► “Lie between everyday working hypotheses and …grand theories” Merton (1968)

33. 3/28/201833 Midrange Theories ► Tend to focus on concepts of interest to nurses  Pain, empathy, grief, self esteem, hope, comfort, dignity, quality of life ► Some midrange theories have their basis in grand theories  Midrange theory of self-care deficit grew out of Orem’s (1980) grand theory of ‘self care’

34. 3/28/201834 Midrange Theories ► Categorized by level of abstraction  High, middle and low ► K. Kolcaba: Theory of Comfort ► R. Mercer: Maternal Role Attainment ► AACN: The Synergy Model for Patient Care

35. 3/28/201835 Microrange Theory ► Closely related to midrange theories  More narrow in scope ► Described at the level of hypothesis ► Questions/ hypotheses derived from practice

36. 3/28/201836 Critique Criteria ► Is the theoretical or conceptual framework clearly identified? ► Is the framework consistent with a nursing perspective? ► Is the framework appropriate to guide research on the topic? ► Is there logical connection between the framework, concepts and the measurement?

37. 3/28/201837 Critique Criteria ► Are the concepts clearly and operationally defined? ► Was sufficient literature reviewed to support the proposed relationships? ► Is there a logical link between the framework, the study concepts, and the methods of measurement?

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39. 3/28/201839 Fig 1: Conceptual Frame Work based on Imogene King’s Theory of Goal Attainment (1981) INTERACTION SYSTEMS ASSESSMENT INTERVENTION GOAL ATTAINMENT

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