Theoretical Basis of Nursing Notes

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Some of the key takeaways are definitions of concepts like assumptions, constructs, empirical indicators, and hypotheses. It also discusses nursing as a profession and discipline.

The main components of a theory are assumptions, concepts, and propositions. Concepts are the building blocks and propositions describe relationships between concepts.

The steps involved in theory development are concept development, statement development, theory construction, testing theoretical relationships, and application of theory in practice.

Denitions and Characteristics of Theory Terms and Concepts

Assumptions are beliefs about phenomena one must accept as true to accept a theory about
the phenomena as true. Assumptions may be based on accepted knowledge or personal beliefs
and values. Although assumptions may not be susceptible to testing, they can be argued
philosophically.
Borrowed or shared theory is a theory developed in another discipline that is not adapted to
the worldview and practice of nursing.
Concepts are the elements or components of a phenomenon necessary to understand the
phenomenon. They are abstract and derived from impressions the human mind receives about
phenomena through sensing the environment.
Conceptual model is a set of interrelated concepts that framework symbolically represents
and conveys a mental image of a phenomenon. Conceptual models of nursing identify concepts
and describe their relationships to the phenomena of central concern to the discipline.
Constructs are the most complex type of concept. They are comprised of more than one
concept and typically built or constructed by the theorist or philosopher to t a purpose. The
terms concept and construct are often used interchangeably, but some authors use concept
as the more general termall constructs are concepts, but not all concepts are constructs.
Empirical indicators are very specic and concrete identiers of concepts. They are actual
instructions, experimental conditions, and procedures used to observe or measure the concept(s)
of a theory.
Epistemology refers to theories of knowledge or how people come to have knowledge; in
nursing it is the study of the origins of nursing knowledge.
Hypotheses are tentative suggestions that a specic relationship exists between two concepts
or propositions. As the hypothesis is repeatedly conrmed, it progresses to an empirical
generalization and ultimately to a law.
Knowledge refers to the awareness or perception of reality acquired through insight, learning,
or investigation. In a discipline, knowledge is what is collectively seen to be a reasonably
accurate understanding of the world as seen by members of the discipline.
Laws is a proposition about the relationship between concepts in theory that has been
repeatedly validated. Laws are highly generalizable. Laws are found primarily in disciplines that
deal with observable and measurable phenomena, such as chemistry and physics. Conversely,
social and human sciences have few laws.
Metaparadigm represents the worldview of a disciplinethe global perspective that subsumes
more specic views and approaches to the central concepts with which the discipline is
concerned. The metaparadigm is the ideology within which the theories, knowledge, and
processes for knowing nd meaning and coherence. Nursings metaparadigm is generally
thought to consist of the concepts of person, environment, health, and nursing.
Middle range theory refers to a part of a disciplines concerns related to particular topics. The
scope is narrower than that of broad-range or grand theories.
Nursing is a science, an art, and a practice discipline, and involves caring. Goals of nursing
include care of the well, care of the sick, assisting with self-care activities, helping individuals
attain their human potential, and discovering and using natures laws of health
Nursing as Profession An occupation is a job or a career, whereas a profession is a learned
vocation or occupation that has a status of superiority and precedence within a division of work.
In general terms, occupations require widely varying levels of training or education, varying
levels of skill, and widely variable dened knowledge bases. Indeed, all professions are
occupations, but not all occupations are professions
Characteristics of a profession include (1) a dened knowledge base, (2) power and authority
over training and education, (3) registration, (4) altruistic service, (5) a code of ethics, (6)
lengthy socialization, and (7) autonomy
Nursing as Academic Disciplines are distinctions between bodies of knowledge found in
academic settings. A discipline is a branch of knowledge ordered through the theories and
methods evolving from more than one worldview of the phenomenon of concern
Nursing philosophy has been described as a statement of foundational and universal
assumptions, beliefs and principles about the nature of knowledge and thought (epistemology)
and about the nature of the entities represented in the metaparadigm (i.e., nursing practice and
human health processes [ontology])
Nursing Science as the substantive, discipline-specic knowledge that focuses on the human-
universe-health process articulated in the nursing frameworks and theories The goal of nursing
science is to represent the nature of nursingto understand it, to explain it, and to use it for the
benet of humankind.
Nursing epistemology has been dened as the study of the origins of nursing knowledge, its
structure and methods, the patterns of knowing of its members, and the criteria for validating its
knowledge claims
Metatheory refers to a theory about theory. In nursing, metatheory focuses on broad issues
such as the processes of generating knowledge and theory development, and it is a forum for
debate within the discipline
Models are graphic or symbolic representations of phenomena that objectify and present certain
perspectives or points of view about nature or function or both. Models may be theoretical
(something not directly observableexpressed in language or mathematics symbols) or
empirical (replicas of observable realitymodel of an eye, for example).
Ontology is concerned with the study of existence and the nature of reality.
Paradigm is an 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. It describes work to be done and frames an orientation within which the work will be
accomplished. A discipline may have a number of paradigms. The term paradigm is associated
with Kuhns Structure of Scientic Revolutions.
Phenomena are the designation of an aspect of reality; the phenomena of interest become the
subject matter that are the primary concerns of a discipline.
Phenomenology is the study of phenomena and emphasizes the appearance of things as
opposed to the things themselves. In phenomenology, understanding is the goal of science, with
the objective of recognizing the connection between ones experience, values, and perspective.
Philosophy is a statement of beliefs and values about human beings and their world.
Philosophy of science in nursing helps to establish the meaning of science through an
understanding and examination of nursing concepts, theories, laws, and aims as they relate to
nursing practice
Practice or micro theory deals with a limited range of discrete phenomena that are specically
dened and are not expanded to include their link with the broad concerns of a discipline.
Praxis is the application of a theory to cases encountered in experience. Relationship
statements Relationship statements indicate specic relationships between two or more
concepts. They may be classied as propositions, hypotheses, laws, axioms, or theorems.
Taxonomy is a classication scheme for dening or gathering together various phenomena.
Taxonomies range in complexity from simple dichotomies to complicated hierarchical structures.
Theory refers to a set of logically interrelated concepts, statements, propositions, and
denitions, which have been derived from philosophical beliefs of scientic data and from which
questions or hypotheses can be deduced, tested, and veried. A theory purports to account for
or characterize some phenomenon.
Worldview is the philosophical frame of reference used by a social or cultural group to describe
that groups outlook on and beliefs about reality.
Branches of Philosophy
Metaphysics Study of the fundamental nature of reality and existencegeneral theory of
reality
Ontology Study of theory of being (what is or what exists) Cosmology Study of the physical
universe
Epistemology Study of knowledge (ways of knowing, nature of truth, and relationship between
knowledge and belief)
Logic Study of principles and methods of reasoning (inference and argument)
Ethics (axiology) Study of nature of values; right and wrong (moral philosophy)
Esthetics Study of appreciation of the arts or things beautiful
Philosophy of science Study of science and scientic practice Political philosophy Study of
citizen and state

Strategies for Concept Analysis and Concept Development


Clarifying, recognizing, and dening concepts that describe phenomena is the purpose of
concept development or concept analysis. These processes serve as the basis for development
of conceptual frameworks and research studies.
Concept analysis is an approach espoused by Walker and Avant (2005) to clarify the meanings
of terms and to dene terms (concepts) so that writers and readers share a common language.
Steps in Concept Analysis
1. Select a concept.
2. Determine the aims or purposes of analysis.
3. Identify all the uses of the concept possible.
4. Determine the dening attributes.
5. Identify model case.
6. Identify borderline, related, contrary, invented, and illegitimate cases.
7. Identify antecedents and consequences.
8. Dene empirical referents.
Concept synthesis is used when concepts require development based on observation or other
forms of evidence. The individual must develop a way to group or order the information about
the phenomenon from his or her own viewpoint or theoretical requirement.
Three methods of synthesizing concepts are as follows:
1. Qualitative synthesisrelies on sensory data and looking for similarities, differences, and
patterns among the data to identify the new concept
2. Quantitative synthesisrequires numerical data to delineate those attributes that belong
to the concept and those that do not
3. Literary synthesisinvolves reviewing a wide range of the literature to acquire new insights
about the concept or to nd new concepts
Concept derivation perspective is often necessary when there are few concepts currently
available to a nurse that explain a problem area. It is applicable when a comparison or analogy
can be made between one eld or area
Steps in Concept Derivation
1. Select a concept.
2. Determine the aims or purposes of analysis.
3. Identify all the uses of the concept possible.
4. Determine the dening attributes.
5. Identify model case.
6. Identify borderline, related, contrary, invented, and illegitimate cases.
7. Identify antecedents and consequences.
8. Dene empirical referents.

IMPORTANTS OF THEORY IN NURSING

Identify certain standards for nursing practice


Identify settings in which nursing practice should occur and the characteristics of
what the models author considers recipients of nursing care
Identify distinctive nursing processes and technologies to be used, including
parameters for client assessment, labels for client problems, a strategy for planning,
a typology of intervention, and criteria for evaluation of intervention outcomes
Direct the delivery of nursing services
Serve as the basis for clinical information systems including the admission
database, nursing orders, care plan, progress notes, and discharge summary
Guide the development of client classication systems
Direct quality assurance programs

Classication of Theories in nursing


The scope of a theory includes its level of specicity and the concreteness of its concepts and
propositions.
Metatheory, philosophy, or worldview to describe the philosophical basis of the
discipline, grand theory or microtheories to describe the comprehensive conceptual
frameworks, middle range or midrange theory to describe frameworks that are
relatively more focused than the grand theories, and microtheories, situation-specic
theory, or practice theory to describe those smallest in scope.
*Grand theories are the most complex and broadest in scope. They attempt to explain broad
areas within a discipline and may incorporate numerous other theories.
*Middle range theories are substantively specic and encompass a limited number of
concepts and a limited aspect of the real world. They are comprised of relatively concrete
concepts that are operationally dened and relatively concrete propositions that may be
empirically tested.
*Practice theories are also called microtheories, prescriptive theories, or situation specic
theories and are the least complex. Practice theories are more specic than middle range
theories and produce specic directions for practice.
*Partial theories are those in the development stage. In a partial theory some concepts have
been identied and some relationships between them have been identied, but the theory is not
complete.
TYPE OR PURPOSE OF THEORY
Factor-isolating theories are those that describe, observe, and name concepts, properties,
and dimensions. Descriptive theory identies and describes the major concepts of phenomena
but does not explain how or why the concepts are related.
Factor-relating theories, or explanatory theories, are those that relate concepts to one
another, describe the interrelationships among concepts or propositions, and specify the
associations or relationships among some concepts
Situation-relating theories are achieved when the conditions under which concepts are
related are stated and the relational statements are able to describe future outcomes
consistently.
Situation-producing theories are those that prescribe activities necessary to reach dened
goals. Prescriptive theories address nursing therapeutics and consequences of interventions
Process of Theory Development
Concept development-- Specifying, dening, and clarifying the concepts used to describe a
phenomenon of interest
Statement development-- Formulating and analyzing statements explaining relationships
between concepts; also involves determining empirical referents that can validate them
Theory construction Structuring and contextualizing the components of the theory;
includes identifying assumptions and organizing linkages between and among the concepts and
statements to form a theoretical structure
Testing theoretical relationships Validating theoretical relationships through empirical testing
Application of theory in practice Using research methods to assess how the theory can be applied
in practice; research should provide evidence to evaluate the theorys usefulness
Theory EVALUATION Process has been dened as the process of systematically examining a
theory. Criteria for this process are variable, but they generally include examination of the
theorys origins, meaning, logical adequacy, usefulness, generalizability, and testability.
THEORY DESCRIPTION is the initial step in the evaluation process. In theory description, the
works of a theorist are reviewed with a focus on the historical context of the theory. In addition,
related works by others are examined to gain a clear understanding of the structural and
functional components of the theory. The structural components include assumptions, concepts,
and propositions. The functional components consist of the concepts of the theory and how they
are used to describe, explain, predict, or control
THEORY ANALYSIS is the second phase of the evaluation process. It refers to a systematic
process of objectively examining the content, structure, and function of a theory. Theory analysis
is conducted if the theory or framework has potential for being useful in practice, research,
administration, or education. Theory analysis is a nonjudgmental, detailed examination of a
theory, the main aim of which is to understand the theory (Fawcett, 1993; Meleis, 2007).
THEORY EVALUATION , or theory critique, is the nal step of the process. Evaluation follows
analysis and assesses the theorys potential contribution to the disciplines knowledge base. ).
This involves evaluation of how the theory is used to direct nursing practice and interventions
and whether or not it contributes to favorable outcomes (Hickman, 2002).
Synthesized Method for Theory Evaluation
THEORY DESCRIPTION What is the purpose of the theory? (describe, explain, predict,
prescribe) What is the scope or level of the theory? (grand, middle range, practice) What are the
origins of the theory? What are the major concepts? What are the major theoretical propositions?
What are the major assumptions? Is the context for use described?
THEORY ANALYSIS Are concepts theoretically and operationally dened? Are statements
theoretically and operationally dened? Are linkages explicit? Is the theory logically organized? Is
there a model/diagram? Does the model contribute to clarifying the theory? Are the concepts,
statements, and assumptions used consistently?
Are outcomes or consequences stated or predicted?
THEORY EVALUATION Is the theory congruent with current nursing standards? Is the theory
congruent with current nursing interventions or therapeutics? Has the theory been tested
empirically? Is it supported by research? Does it appear to be accurate/valid? Is there evidence
that the theory has been used by nursing educators, nursing researchers, or nursing
administrators? Is the theory socially relevant? Is the theory relevant cross-culturally? Does the
theory contribute to the discipline of nursing? What are implications for nursing related to
implementation of the theory?

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