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The development of a theory Shu-Fang Vivienne Wu Assistant professor NTUNHS Objectives Define theory and list characteristics of a theory Describe the components of a theory and its use Trace the development of a nursing theory Theory Development in Nursing: Historical Overview Describe the different types of theories and examples of each. Introduction to Theory Nursing as a profession There has been questions about whether nursing is a profession or an occupation. An occupation is a job a career. A profession is a learned vocation or occupation that has status of superiority and precedence within a division of work. It needs widely varying levels of training or education, skills and variable knowledge base. All professions are occupations but not all occupations are professions (Logan,Franzen, Butcher,2004;Schwiran , 1998) Definitions of theory Defining theory is the first step towards developing a set of criteria for the evaluation of theory. Many of the early definitions of theory in the nursing literature were influenced by the Logical Positivistic Received View (Suppe, 1977), where the focus was on structure and process. Ex.1.McKay (1969) defines theory as “a logically interrelated set of confirmed hypotheses” (p. 394)and Jacox (1974) defines it as “a systematically related set of statements including law-like generalizations that are empirically testable” (p. 324). These definitions are consistent with the Received View philosophy on theory at the time. Definitions of theory Chin and Jacobs (1983) define theory as “a set of concepts, definitions, and propositions that projects a systematic view of phenomena by designating specific interrelationships among concepts for purposes of describing, explaining, predicting, and/or controlling phenomenon” (p. 70). This definition begins a departure from the Logical Positivistic Received View, in that it does not emphasize the structure of the theory. Problem in nursing:lack of agreement on the definition of theory Many authors have used the term theory as interchangeable with such terms as conceptual framework, conceptual model, model, and paradigm. Fawcett (1989) clearly states that “conceptual models and theories are clearly distinguished by their levels of abstraction and thus must be used in different ways” . She defines nursing theory as “a relatively specific and concrete set of concepts and propositions that purports to account for or characterize phenomena of interest to the discipline of nursing” (p. 23). A conceptual model vs. A theory A conceptual model is an abstract and general system of concepts and propositions. A theory deals with one or more relatively specific and concrete concepts and propositions”(Dudley-Brown p.77) . Distinguish a conceptual model from a theory If the purpose is to describe, explain, or predict specific phenomena, the work is most likely a theory. Ex. the works of Peplau (Alligood & Tomey Ch 5, p.54) and Orlando. If the purpose of the work is to articulate a body of distinct knowledge for the discipline of nursing, the work is most likely a conceptual model. Ex. the works of Johnson, King, Levine, Neuman, Orem, Rogers, and Roy. Distinguish a conceptual model from a theory Most of these theorists have been described by others as proposing a nursing theory, not a conceptual model. Failure to distinguish a conceptual model from a theory, Fawcett (1989) states, leads to misunderstandings and inappropriate expectations of the work. However, according to Meleis (1985), the use of different labels (theory, paradigm, model, and framework) corresponds to differences in emphasis rather than substance. Definitions of theory • Pinnel and Menesis (1986) Systematic set of interrelated concepts, definitions and deductions that describe, explain or predict interrelationships Definitions of a theory Walker and Avant (1983) Internally consistent group of relational statements (concepts, definitions and propositions) that presents a systematic view of phenomenon and which is useful for description, explanation, prediction and control Definition of a theory Chinn and Krammer creative and vigorous structuring of ideas that project a tentative, purposeful and systematic view of phenomena Definitions of a theory Meleis,2005 Theory is an organized, coherent, and systematic articulation of a set of statements related to significant questions in a discipline that are communicated in a meaningful whole. Some commonalities Purpose Concepts Definitions Propositions Structured ideas Tentative Describe a phenomenon or occurrence Components/Elements of theory 1.Purpose “Why is the theory formulated” 2.Concepts are building blocks of theory – ideas, mental images of a phenomenon, an event or object that is derived from an individual’s experience and perception Components/Elements of theory 3.Has a major concept like nursing, person, health or environment. 4. Definitions give meaning to concepts which can either be descriptive or procedural (stipulate-use of term within the theory) Components/Elements of theory Propositions are expressions of relational statements between and among the concepts. It can be expressed as statements, paradigms or figures . AKA as theoretical assertions Assumptions- accepted “truths” that are basic and fundamental to the theory. Or value assumptions where what is good or right or ought to be. Characteristics of a Theory • Systematic, logical and coherent (orderly reasoning,no contradictions) • Creative structuring of ideas mental images of one’s experiences and create different ways of looking at a particular event or object. • Tentative in nature ( change over time or evolving but some remain valid despite passage of time) Theory Development How does a theory develop? Four strategies of theory development 1. Theory practice theory ( theory developed in other discipline and used in nursing situations) 2. Practice – theory evolved from clinical practice How does a theory develop? 3. Research theory or inductive method Must evolve from research findings or empirical evidence. 4. Theory research theory theories developed by other disciplines are utilized but given unique nursing perspective. Original theory examined and given a new research findings. TERMINOLOGY METAPARADIGM - Most abstract level of knowledge. In nursing this is main concepts that encompasses the subject matter and the scope of the discipline - Central concepts of person, environment, health and nursing TERMINOLOGY Philosophy - Knowledge level which specifies the definitions of the metaparadigm concepts in each of the conceptual models of nursing. - Nightingale is considered philosophical approach - Out of these philosophies theory maybe formalized Conceptual models Frameworks or paradigms that provide a broad frame of reference for the systematic approaches to the phenomena with which the discipline is concerned. different views nursing like Roy focuses on adaptation, King on interaction and Abdellah on interventions Theory Group of related concepts that propose actions that guide practice Nursing theory Group of related concepts that derive tfrom the nursing models. Some derive from other nursing discipline like LEininger which comes from anthropology Nursing theory is defined as a conceptualization of some aspect of nursing reality communicated for the purpose of describing phenomena, explaining relationships between phenomena, predicting consequences, or prescribing nursing care(Meleis,2005). Uses of theory 1. Theory guides and improve nursing practice Theory provides goal for nursing care and with goals, nursing practice is rendered more effective and efficient. Theories help to focus the goals, making nurses more confident about the practice. Uses of theory 2. Theory guides research according to Meleis, primary use of theory is to guide research. It validates and modifies the theory. 3. Theory contributes to the development of the disciplines body of knowledge 4. Theory enhances communication Theory Development in Nursing: Historical Overview Where do I begin? Florence Nightingale - Considered first modern nursing theorist - First one to delineate what is considered the nursing goal and practice domain. - “ placing the client in the best condition for nature to act upon him” - Taught about symptoms and what they indicate, rationale for actions and trained powers of observation and reflection Historical Development of Nursing Theories: Significant Events Nightingale until the 50’s Florence Nightingale Notes on Nursing control of the environment to care for the individual (ventilation, light, warm , noise absence or reduction, cleanliness & diet ) 1952 Nursing Research Journal publication 1960’s nature of nursing practice was debated, defined nursing practice, or develop nursing theory, and created a substantive body of knowledge Historical development 1960-1970 proliferation of conceptual models and frameworks, and philosophy of nursing. Examples: Abdellah 21 nursing problems and Hall’s Core, care and cure (person,body,disease) 1969 first conference on nursing theory Historical Development Role of nurses where questioned; what they do, for whom where and when were determined. purpose of nursing, process of theory development was discussed Historical Development 1980’s characterized by acceptance of the significance of theory in nursing. Less debates on whether or not to use theory, practice theory or borrowed ones. More and more publication up to the present. Types of theories According to range Grand theory Middle range theory Micro theory Types of theories: Grand Theory Grand Theory consist of broad conceptual frameworks that reflect wide and expansive perspectives for practice and ways of describing, explaining, predicting and looking at nursing phenomena. They are the most complex and broadest in scope. Ex. Henderson’s The Nature of Nursing ; Levine’s The Four Conservation Principles of Nursing, Roy’s Adaptation Model, and Orem’s Self-Care (Marriner-Tomey) Types of Theories: Mid Range- Mid Range- less complex and narrower in scope than grand theory and micro theory. A more workable level is the middle range.more limited in scope and less variables, and testable. grand theory on stress and adaptation might not yield any interpretable guidelines on practice but if the theory is focused on chronic lingering illness as the stressor on family, the stress theory becomes operational for both research and practice purposes. Ex. Peplau’s Psychodynamic Nursing and Orlando’s Nursing Process Theory Types of theories: Micro theories Micro theories- are the least complex. They contain the least complex concepts and are narrowest in scope. They deal with a small aspect of reality, generally a set of theoretical statements Deals with specific and narrow defined phenomena According to Orientation or focus of the theory 1. Client centered: Nightingale, Henderson 2. Client-nurse dynamics: Watson 3. Client-nurse environment : Leininger Categories of nursing theories client nurse ` environment Client centered theory Focused on the needs and problems of clients which are met, resolved or alleviated by nursing interventions This category includes theories developed by the following : Nightingale,Abdellah,Henderson,Orem,Pend er, Roy, Levine, Hall. Nurse – client dynamics Focus on interaction between the nurse and client. This category includes theories developed by the following: Peplau, Watson, King and Orlando Client Nurse Environment Dynamics Focus on the interaction between nurse and client in an environment that includes broader dimensions of time and space. As well as culture, cultural diversity, and universality. Theories of Neuman and Leininger are discussed under this category. Framework to Analyze the Nursing theory 1.What are the major concepts? Person, nursing, health and environment 2. Based on Focus Client centered, nurse-client dynamics, nurse client- environment dynamics -How similar and how different are their concepts of persons, nursing, health, environment 3. Key concepts unique to the theory. Some theories have several key concepts and it may have sub-concepts. Analysis of theory Clarity－How clear is this theory? Simplicity－How simple is this theory? Generality－How general is this theory? Empirical precision －How accessible is this theory? Derivable consequences －How important is this theory? Conclusion Theory development and evaluation are cyclical, continuous, and dynamic process. One can not exist without the other. Theory evaluation including description, concept analysis, theory critique, testing and support. These process are based on the view that science is a human process that includes not only valid findings but also observation, agreements, useful solutions to problems. Theory evaluation is central to the development of theory; it is the responsibility of each clinician, academician. Exercise Please see the attachment: Adaptation model of nursing 1.Define theory and list characteristics of a theory 2.Describe the components of a theory and its use 3.Trace the development of a nursing theory 4.Theory Development in Nursing: Historical Overview
"Theoretical Foundations of Nursing"