1. Chapter 2 Overview of Theory in Nursing

2. 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

3. 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

4. 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

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

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

7. 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)

8. 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.

9. 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

10. 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

11. 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

12. 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

13. 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

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

15. 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

16. 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.

17. 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.

18. 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

19. 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

20. 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.

21. 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.

22. 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

23. 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

24. 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

25. 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

26. Scope of Theory Metatheory Grand theory Middle range theory
Practice theory

27. 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

28. 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

29. 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.

30. 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

31. 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

32. Comparison of the scope of nursing theories.

33. Types of Theory Descriptive theory Explanatory theory
Predictive theory
Prescriptive theory

34. 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

35. 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

36. 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.

37. 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

38. 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

39. 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)

40. 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.”

41. 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

42. 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.

43. 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

44. 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

45. 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

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