DEVELOPMENT OF DEVELOPMENT OF

NURSING PRACTICE NURSING PRACTICE THEORYTHEORY

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Objectives

Define theory and list characteristics of a theory

Trace the development of a nursing theory

Describe the components of a theory and its use

Describe the different types of theories and

examples of each.

THEORYTHEORY

Greek word “theoria” mean vision A group of interrelated concepts

• Represents a phenomena• Explains an event• Show systematic relationships

• Proposes action and guides practices

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FRAMEWORK

• A structure • A plan

• An out line • A foundation

That provide a broad frame of reference for That provide a broad frame of reference for approaching a phenomena approaching a phenomena

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MODEL MODEL

• Symbol• Drawing • Words or formula • Diagrams

A model is graphic or symbolic representation A model is graphic or symbolic representation of phenomena that facilitate understating of phenomena that facilitate understating

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Components/Elements of theoryComponents/Elements of theory

PropositionsPropositions

• Are expressions of relational statements between

and among the concepts. It can be expressed as

statements, paradigms or figures AssumptionsAssumptions

• Accepted “truths” that are basic and fundamental to

the theory. Or value assumptions where what is

good or right or ought to be. 3-8

CHARACTERISTICS OF A CHARACTERISTICS OF A THEORYTHEORY

Systematic, logical and coherent Systematic, logical and coherent (orderly reasoning,

no contradictions)

Creative structuring of ideas 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 Tentative in nature ( change over time or evolving

but some remain valid despite passage of time)

KNOWLEDGE DEVELOPMENT IN NURSING

The knowledge in a particular discipline can be arranged in a hierarchical structure that ranges from abstract to concrete.

Theories represent the most concrete component of a discipline.

Several theories that share a common view of the world can be grouped together to form a paradigm.

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NURSING KNOWLEDGE NURSING KNOWLEDGE

A Paradigm is a particular viewpoint or perspective. Each discipline has a defined Metaparadigm, which is the most abstract component of knowledge and which can consist of more than one paradigm (Fawcett, 1989).

A Metaparadigm is the unifying force in a discipline that names the phenomena of concern to that discipline.

The Metaparadigm of Nursing

What is it that distinguishes nursing from any other What is it that distinguishes nursing from any other discipline such as biology, sociology, or psychology? discipline such as biology, sociology, or psychology?

“Each discipline singles out certain phenomena with which it will deal in a unique manner” (Fawcett, 1989, p. 5).

The field of biology has defined limits and boundaries that do not extend into psychology. Psychology does not extend its concerns into the domain of sociology, which has as its main focus the social behavior of human beings.

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The Metaparadigm of Nursing

Disciplines are distinguished from each other by differing metaparadigm concepts. Most metaparadigms consist of several major concepts.

The major concepts that provide structure to the domain of nursing are person, environment, health, person, environment, health, and and nursingnursing.

Each nursing theory presents a slightly different view of the metaparadigm concepts.

NURSING KNOWLEDGE NURSING KNOWLEDGE

Paradigm revolution is the turmoil and conflict that occur in a discipline when a competing paradigm gains acceptance over the dominant paradigm. If the competing paradigm answers more questions and solves more problems for the discipline than the prevailing paradigm, then a paradigm shift occurs.

Paradigm shift refers to the acceptance of the competing paradigm over the prevailing paradigm or a shifting away from one worldview toward another worldview. Again, by consensus the competing paradigm becomes the dominant paradigm and the process begins again. (Kuhn, 1970Knowledge is developed that makes a difference Knowledge is developed that makes a difference

in health carein health care

PARADIGMS IN NURSING PARADIGMS IN NURSING

Several nursing scholars have proposed that the discipline of nursing is in the midst of a paradigm revolution.

Several authors have present different paradigms in nursing

According to Parse (1987), there are currently two paradigms in nursing: 1. Totality Paradigm

2. Simultaneity Paradigm

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PARADIGMS IN NURSING PARADIGMS IN NURSING

Totality Paradigm• “The goals of nursing in the totality paradigm focus on health

promotion, care and cure of the sick, and prevention of illness. Those receiving nursing care are persons designated as ill by societal norms”

Simultaneity Paradigm• “The goals of nursing in the simultaneity paradigm focus on

the quality of life from the person’s perspective. The authority and prime decision maker in regard to nursing is the person not the nurse”

(Parse, 1987).

DEBATE, DIALOGUE, DISCUSSION, DEBATE, DIALOGUE, DISCUSSION, THEORY DEVELOPMENTTHEORY DEVELOPMENT

Some nursing scholars argue about the structural elements of the discipline; some debate the value of competing paradigms; and some present alternative metaparadigm elements.

Yet, Yet,

with all the uncertainty that is created by these questions with all the uncertainty that is created by these questions and alternative ideas, the ongoing dialogue is a healthy and alternative ideas, the ongoing dialogue is a healthy

sign of the development of the nursing profession. sign of the development of the nursing profession.

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THEORY DEVELOPMENT THEORY DEVELOPMENT

SEVERAL FACTORS TO BE EXAMINESEVERAL FACTORS TO BE EXAMINE

• Relationship among theory, research and practice

• Approaches to theory development based on the

source of initiation

• Process of theory development

RELATIONSHIP BETWEEN THEORY, RELATIONSHIP BETWEEN THEORY, AND RESEARCH AND RESEARCH

Theory • An explanation about how and why something is• It allows to go beyond the known facts,

suggesting what you might expect in the future, and allowing you to organize the facts you already have.

• Research validates and modifies theory • It explore significant nursing problem

potential for development of nursing knowledge

RELATIONSHIP BETWEEN THEORY RELATIONSHIP BETWEEN THEORY AND PRACTICE AND PRACTICE

The so-called correlation of theory and practice seems to be a continuing issue of concern.

Theory and practice are reciprocally related.

"Theory without practice is sterile and practice "Theory without practice is sterile and practice without theory is blind” without theory is blind”

Practice is the basis for nursing theory development and nursing theory must be validated in practice

RELATIONSHIP BETWEEN THEORY RELATIONSHIP BETWEEN THEORY AND PRACTICE AND PRACTICE

How does theory influence practice ? Organizes nursing care Sets standards for practice Describes settings in which practice occurs Identifies recipients of nursing care. Sets the nursing process format and content. Designs systems of nursing care delivery.

The Theory Practice Gap The Theory Practice Gap

The so-called integration of theory and practice has The so-called integration of theory and practice has not yet been achieved, but seems to be a not yet been achieved, but seems to be a

continuing issue of concern. continuing issue of concern.

RELATIONSHIP BETWEEN THEORY RELATIONSHIP BETWEEN THEORY AND PRACTICEAND PRACTICE

Research is the key to the development of a discipline

Middle ranged and practice theory may be tested in practice through clinical research

There is need to encourage nurses to test and refine theories and model to develop their own personal models of practice

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THEORY DEVELOPMENT THEORY DEVELOPMENT

Four strategies of theory development1.1. THEORY PRACTICE THEORY THEORY PRACTICE THEORY ( theory developed

in other discipline and used in nursing situations)

2.2. PRACTICE THEORY PRACTICE THEORY evolved from clinical practice

3.3. RESEARCH THEORY OR INDUCTIVE METHOD RESEARCH THEORY OR INDUCTIVE METHOD Must evolve from research findings or empirical evidence.

4. THEORY RESEARCH THEORY THEORY RESEARCH THEORY theories developed by other disciplines are utilized but given

unique nursing perspective. Original theory examined and given a new research findings.

APPROACHAPPROACH 1 1

THEORY PRACTICE THEORYTHEORY PRACTICE THEORY Selection of theory may be used to describe a clinical situation

(Stress, adaptation)

Modify concepts and its relationships • Have basic knowledge of non nursing theory

• Theory analysis • Use assumption, proposition to describe clinical situation • Refine assumption, proposition and concepts to reflect nursing • Reconstruct a theory

Examples Benner’s use of Dreyfus’ Model of skill Acquisition Examples Benner’s use of Dreyfus’ Model of skill Acquisition

APPROACH 2APPROACH 2

PRACTICE THEORY PRACTICE THEORY evolved from clinical practiceNo appropriate theory exist Inductively developed from clinical situation Grounded theory approach is used

Observation of new phenomena Development of concepts

Labeling, describe the properties of concepts

Analysis Develop concepts and propositional statement and linkage

Example A model for multicultural nursing Example A model for multicultural nursing ( Rooda, ( Rooda, 1992)1992)

APPROACH 3APPROACH 3

RESEARCH THEORY OR INDUCTIVE METHODRESEARCH THEORY OR INDUCTIVE METHODScientific Theory Scientific Theory Most accepted strategy for theory development Select a phenomena and list its characteristics Develop a measurement toolMeasurement are analyzedDiscovery of patternFormulation of theoretical statement

Example

Development of taxonomy of passive behavior in people with Development of taxonomy of passive behavior in people with Alzheimer disease Alzheimer disease

Approach 4Approach 4

THEORY RESEARCH THEORYTHEORY RESEARCH THEORY Theory Testing

• Theory derives the Research Question • Theory is selected to explain the phenomena of interest • Redefined • Finding synthesized

- Used to modify, refine or develop original theory , new theory

Example Peaceful end of life Example Peaceful end of life (Ruland and Moore, 1998)

PROCESS OF THEORY DEVELOPMENT PROCESS OF THEORY DEVELOPMENT

THREE BASIC STEPSTHREE BASIC STEPS

1. Concept Development Creation of conceptual meaning

1. Statement development Formulation and validation of relational statement

1. Theory Construction Systematic organization of linkages

Two Additional Steps4. Empirical Testing (correlating the theory with demonstrable experience)

5. Application of theory

PROCESS OF KNOWLEDGE PROCESS OF KNOWLEDGE DEVELOPMENTDEVELOPMENT

IMPORTANCE OF NURSING IMPORTANCE OF NURSING THEORIESTHEORIES

Nursing theory aims to describe, predict and explain the phenomenon of nursing (Chinn and Jacobs,1978)

It should provide the foundations of nursing practice, help to

generate further knowledge and indicate in which direction nursing should develop in the future (Brown, 1964)

Theory is important because it helps us to decide what we know

and what we need to know (Parsons,1949) It helps to distinguish what should form the basis of practice by

explicitly describing nursing.

IMPORTANCE OF NURSING THEORIESIMPORTANCE OF NURSING THEORIES

The benefits of having a defined body of theory in nursing include better patient care, enhanced professional status for nurses, improved communication between nurses, and guidance for research and education (Nolan, 1996)

The main exponent of nursing – caring – cannot be measured, it is vital to have the theory to analyse and explain what nurses do.

As medicine tries to make a move towards adopting a more multidisciplinary approach to health care, nursing continues to strive to establish a unique body of knowledge.

This can be seen as an attempt by the nursing profession to maintain its professional boundaries.

3-36Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.