Nursing Theory Development

Introduction

Key terms

o   A systematic explanation of an event in which, constructs and concepts are identified, and relationships are proposed, and predictions made.

·         Theory development

o   It is the process and methods used to create, modify or refine an existing theory.

·         Nursing theory

o   Nursing theory is the conceptualization of some aspect of reality ( invented/discovered) that pertains to nursing.

o   The conceptualization is articulated for the purpose of describing, explaining, predicting, or prescribing care.

Essential factors of theory development

·         Understanding of the relationship among theory, research and practice

·         Awareness about various approaches to theory development

·         The process of theory development

Importance of nursing theory to practice

·         Nursing theory should provide the principles that underpin practice and help to generate further nursing knowledge.⁶ 

·         The philosophy and theory of nursing serves as the foundation for clinical practice, management, and research in nursing.⁷

·         There are factors relating to theory and practice that might be challenging in the evolution of the nursing profession and that need to be taken into consideration, such as the persistent separation of both of these elements in the reality of nursing.

·         The knowledge of philosophical and theoretical content would support nurses to understand the person’s illness and well-being in the lifespan.⁸

·         The rapid changes in health services and technologies require new types of expertise in nursing to take care of patients.⁹

Relationship between theory and research¹⁰

·         Theories explain relationship among variables

·         Research validates and modifies theory

·         The results of research can be used to verify, modify, improve or support a theoretical proposition

Relationship between theory and practice

·         Theory guides practice.

·         Theory renders more efficient and more effective practice which ultimately improves client care.

·         Through practice nursing theory is shaped and guidelines for practice evolve.

Relationship between research and practice

·         Research is the key to the development of a discipline

·         Middle range and practice theories may be tested in practice through clinical research.

Types of theories

·         Based on the level of abstraction

o   Grand theories

o   Middle range theories

o   Situation specific theories

·         Based on goal orientation

o   Descriptive theories

o   Prescriptive theories

·         Based on types of Knowledge

o   Clinical

o   Conceptual

o   Empirical knowledge

Four Nursing Meta paradigm Concepts

·         Person

·         Health

·         Environment

·         Nursing

Theorizing in Nursing

·         The first nursing theorist, Florence Nightingale, created detailed reports of both medical and nursing matters as chief nurse for the British in the Crimean War in the mid-1850s.¹⁰

·         Late 1800s–1900 - Nursing viewed as an apprenticeship

·         1900–1950s - Growing emphasis on need to identify a body of nursing knowledge

·         Hildegard Peplau published Interpersonal Relations in Nursing in 1952, based on her work as a psychiatric nurse.¹¹

·         1960s saw the beginning of grand theories.

·         1970s – journals on nursing research and education were started.

·         1980s – patients and patient behaviour-focused research started in the West.

·         1990s – evidence based practice and research utilization were the focus & clinical revolution in nursing in response to societal, medical, scientific, and technologic advances. 

·         2000s and present- qualitative and quantitative research addressing more explanatory or predictive-level questions

·         Theorizing in nursing evolves from extending other theories, abstracting from practice or synthesizing research findings or any combination of these types.

Origin	Basis for development	Type of theory	Methods for development
Theory- practice-  theory	An existing non nursing theory	Borrowed or shared theory	Selects & analyses a theory. Defines, evaluates, redefines concepts & propositions
Practice-  theory	Theory is derived from clinical situations	Grounded theory	Observes phenomenon, analyzes, compares & contrasts responses and develops concepts & linkages
Research-  theory	Research	Scientific theory	Selects & measures characteristics of a phenomenon in various situations. Analyses & formalizes patterns
Theory-  research- theory	Theory derives research questions. Research modifies theory	Theory testing	Theory is modified, refined, or further developed based on research findings. New theory may be formed Theory testing research continues to advance discipline.

Patterns of theorizing

·         Nurses often use a combination of patterns of knowing in decision-making.¹²

·         Three patterns of knowing was identified by Rafi F (2021)¹³

o   1. “cohesion of patterns of knowing”

o   2. “domination of some patterns of knowing” 

o   3. “elimination of some patterns of knowing”

·         Theory, inquiry, and evidence are inextricably linked. Each pattern of knowing can be considered a type of theory, and the modes of inquiry appropriate to the generation and testing of each type of theory provide diverse sources of data for evidence-based nursing practice.¹⁴

Component	Clinical	Conceptual	Empirical
Phenomena	Discovered	Discovered	Created
Concepts	Emerged from phenomenon	Used as per  Theory or redefined	Redefined & modified due to research
Propositions	Linkages evolve from experience	Theoretical properties evolve from theory	Deduced from theory
Theory	Descriptive/  explanatory/ prescriptive	Descriptive/Explanatory	Descriptive / Predictive
Purpose	·         Explain ·         Describe ·         Development of  theory ·         Clinical practice	Development of theory	Development of theory / Research
Approach	Clinical experience	Conceptualization	Measurement testing
Evaluation	Guided by practice situation	Guided by theory	Guided by research

Strategies for theory development

·         Synthesis – information based on observation is used to construct a new concept, new statement or theory. Synthesis allows the theorist to construct a theory by connecting isolated pieces of information that are yet theoretically unconnected.

·         Derivation – the theorist transposes and redefines a concept, statement or theory from one context or field to another.

·         Analysis – theorist clarifies, redefines, or sharpens concepts, statements or theories.

Process of Theory Development

·         Concept development: creation of conceptual meaning

·         Statement development: Formulation and validation of relational statements

·         Theory construction: systematic organization of the linkages

·         Testing theoretical relationships

·         Theory application

Strategies for Concept Development

·           Concept  exploration

·           Concept clarification

·           Concept analysis

Conclusion

·         Concepts are the cornerstones of every discipline.

·         The progress of the discipline can be measured by the extent to which its members are able to uncover and develop concepts that reflect the phenomena related to nursing care.

·         Systematic research is an essential step in the process to complete the practice-theory-research loop.

References

1. May, C.R., Mair, F., Finch, T. et al. Development of a theory of implementation and integration: Normalization Process Theory. Implementation Sci 4, 29 (2009). https://doi.org/10.1186/1748-5908-4-29.

2. Kiikkala I. Käsitteistä käsitejärjestelmiin [Concept development in theory development]. Sairaanhoitaja (1991). 1994;(3):23-4. Finnish. PMID: 8054649.

3. Craig SL. Theory development and its relevance for nursing. J Adv Nurs. 1980 Jul;5(4):349-55. doi: 10.1111/j.1365-2648.1980.tb00975.x. PMID: 6902728.

4. Craig SL. Theory development and its relevance for nursing. J Adv Nurs. 1980 Jul;5(4):349-55. doi: 10.1111/j.1365-2648.1980.tb00975.x. PMID: 6902728.

5. Botha ME. Theory development in perspective: the role of conceptual frameworks and models in theory development. J Adv Nurs. 1989 Jan;14(1):49-55. doi: 10.1111/j.1365-2648.1989.tb03404.x. PMID: 2926015.

6. Colley S. Nursing theory: its importance to practice. Nurs Stand. 2003 Jul 30-Aug 5;17(46):33-7. doi: 10.7748/ns.17.46.33.s56. PMID: 12961951.

7. Rega ML, Telaretti F, Alvaro R, Kangasniemi M. Philosophical and theoretical content of the nursing discipline in academic education: A critical interpretive synthesis. Nurse Educ Today. 2017 Oct;57:74-81. doi: 10.1016/j.nedt.2017.07.001. Epub 2017 Jul 13. PMID: 28750250.

8. Rega ML, Telaretti F, Alvaro R, Kangasniemi M. Philosophical and theoretical content of the nursing discipline in academic education: A critical interpretive synthesis. Nurse Educ Today. 2017 Oct 1;57:74–81.

9. Hansen BS, Dysvik E. Expanding the theoretical understanding in Advanced Practice Nursing: Framing the future. Nurs Forum (Auckl). 2022;57(6):1593–8.

10. Stolley JM, Buckwalter KC, Garand L. The Evolution of Nursing Research. J Neuromusculoskel Syst JNMS J Am Chiropr Assoc Inc. 2000;8(1):10–5.

11. Peplau H Interpersonal Relations in Nursing. New Youk: Putnam, 1952. 

12. Guadron MB. Identification of patterns of knowing used by rural community health nurses in decision-making. State University of New York at Binghamton; 2008. 

13. Rafii F, Nasrabadi AN, Tehrani FJ. How Nurses Apply Patterns of Knowing in Clinical Practice: A Grounded Theory Study. Ethiop J Health Sci. 2021 Jan;31(1):139-146. doi: 10.4314/ejhs.v31i1.16. PMID: 34158761; PMCID: PMC8188100.

14. Fawcett J, Watson J, Neuman B, Walker PH, Fitzpatrick JJ. On nursing theories and evidence. J Nurs Scholarsh. 2001;33(2):115-9. doi: 10.1111/j.1547-5069.2001.00115.x. PMID: 11419305.

This page was last updated on: 30/08/2023