Theoretical nursing: development and progress Discussion
Theoretical nursing: development and progress Discussion
The theory era began with a strong emphasis on knowledge development. Although in the previous two decades proponents of nursing theory and nursing theorists had begun to publish their works, it is noteworthy that they denied being theorists when they were introduced as such at the 1978 Nurse Educator Conference in New York with the Nursing Theory theme. There was understanding among those attending the conference that the presenters were theorists, and by the second day, the audience responded to their denials with laughter. This seems strange today, but this was the first time most of the theorists even met each other. Their works had grown out of content organization in nursing education courses, nursing practice administration in large agencies, and structures for the thought and action of practice. It was clear that their works were nursing theoretical structures even before they recognized them as such. The theory era, coupled with the research and graduate education eras, led to understanding of the scientific process beyond production of a scientific product Theory forms the foundation of knowledge. Nursing theories form the foundation of nursing practice, research, and education. Throughout your professional life, you will be applying theory and the knowledge derived from theory in your practice environment regardless of the setting. An understanding of the nature of nursing knowledge from a historical perspective will help you relate better to where nursing theory development is today.
Theory
Theory is defined as “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; a symbolic depiction of aspects of reality that are discovered or invented for describing, explaining, predicting, or prescribing responses, events, situations, conditions, or relationships” (Meleis, 1997, pp. 8,12)1. Thus, a theory is a coherent set of propositions and statements that describe (factor-isolating), explain (factor-relating), and predict (situation-relating) phenomena as well as prescribe (situation-producing) actions toward goals. (Dickoff et al., 1968)2. Theoretical nursing: development and progress Discussion
Theory development requires perceiving phenomena that are peculiar to nursing and proposing meaningful explanation for these perceptions. The nursing profession identifies four levels of theory—metatheory, grand theory, middle range theory, and practice theory. The theories are classified based on their levels of abstraction or complexity.
A complete structure includes a conceptual model, derived theories, and correlated empirical research methods. Each conceptual model and theory is comprised of concepts and propositions. The complete structure forms a hierarchy that is based on levels of abstraction.
Most abstract: the conceptual model that provides the context or frame of reference for theory-generating and theory-testing research
Intermediate level: the theory that is generated or tested
Most concrete: the empirical research methods used to collect and analyze the data
1Meleis, A. I. (1997). Theoretical nursing: development and progress (3rd ed.). Philadelphia: Lippincott.
2Dickoff, J., James, P., & Wiedenbach, E. (1968). Theory in a practice discipline Part 1: Practice oriented theory. Nursing Research, 17(5), 415–435.
Importance of Identification of theory
Early knowledge consisted of loosely connected clusters of concepts. Later knowledge developed interrelated statements connecting the concepts. Advanced theory provided a knowledge base for intervention strategies that clusters of concepts could not.
Identification of theory is important to understand the characteristics of theory structures. A complete theory of nursing identifies the three elements of context, content, and process; some theorists articulate each element better than others.
Context is the environment in which nursing acts occur; the context of a theory describes the nature of the world of nursing and may describe the nature of the patient’s world.
Content includes the subject matter of a theory; this comprises the stable components that are acted on or that do the acting
Process implies the action part of the theory, the intervention elements.
In addition to these elements, all theories should be examined for certain common factors:
Theories should be based on concepts and propositions
Theories should be specific to the nursing context
Theories can be applied to many situations
Theories should be relevant to potential users
Theories should be easy to define it in operational terms
Theories should correspond with empirical findings
Theories should demonstrate internal consistency.
Florence Nightingale made the first attempts at theory-based nursing during the late 19th and early 20th centuries. She organized a group of women to deliver care under her supervision and that of war surgeons. She established the need for hygiene, with environmental change as the means to enhance healing. For her, the nursing domain was the patient and the environment in which care was offered. Her goals were to expose the unhealthy conditions of soldiers, to gain support for the need for nurses, and to achieve formal education for nurses. She was the first to use data collection and analysis to prove efficacy of nursing actions.
The Nursing-Theory Connection
The new millennium has witnessed a rapid change in the global healthcare arena. This profession is continually evolving to face the monumental changes that have emerged. In the past, nursing theories were taught strictly from an academic point of view. Those in practice saw little connection or integration of theory and practice. However, the contemporary move toward evidence-based practice has seen nursing professionals applying theory to describe, predict, and prescribe nursing practice.
Theoretical nursing: development and progress Discussion
Relevance to Present and Future
Theories are a reflection of the past, present, and future of nursing. Understanding the relevance of theories will enhance the relationship of concept with practice. This will help you comprehend the complex phenomena and interconnectedness between theory and practice and build a new way of thinking, understanding, working, and living.
Relevance to Research
Research on theories help in the systematic investigation of the domain of knowledge. Research acts as a source of knowledge development. Research studies conducted on nursing theories help highlight the interlinking cyclical connection between theory and practice. Learners get an idea about the interconnectedness between real world clinical issues, theory, and actual research.
Nursing theories
Nursing theories are normally derived from conceptual models in which the nursing metaparadigm phenomena are clearly identified (Fawcett, 1983)3. For this reason, the conceptual model is considered a precursor of nursing theory (Peterson, 1977; Fawcet 1983)4. A conceptual model of nursing is a set of abstract concepts and propositions that are integrated into a meaningful configuration and represents an involvement in theoretical formulations by describing nursing phenomena and their interrelationships in abstract terms (Fawcett, 1983).
The concepts of a conceptual model are so abstract and general that they often cannot be observed or tested directly and may not even be defined. The concepts and definitions of each conceptual model are often stated in a distinctive vocabulary where the meaning of each term is connected to the unique focus of the conceptual model. Therefore, the same terms may have different meanings in different conceptual models.
Each conceptual model provides a different perspective from which to view the phenomena that are within the domain of inquiry of a particular discipline. Most disciplines have more than one conceptual model; each focuses on certain phenomena that are regarded as relevant and other phenomena are ignored because they are deemed less important.
3 Fawcett, J. (1983). Hallmarks of success in nursing theory development. In P. L. Chinn (Ed.), Advances in nursing theory development. Aspen, DN: Rockville, p. 3–17.
4Peterson, C. J. (1977). Questions frequently asked about the development of a conceptual framework. Journal of Nursing Education, 16( 4 ), 22–32.
Theoretical nursing: development and progress Discussion
My autobiography.
I am currently in Miami, FL. I have been living here since I came from Cuba 17 years ago. I received my RN license in 2017 with an associate degree, and I obtained my BSN last august. Since I received my RN license in 2017, I have worked in home health, clinical trial clinic, med-Surg floor nurse, ER nurse, and how I’m a hospice clinical liaison. I expect to increase my knowledge of nursing theories and how I can apply these theories to nursing. I’m still undecided between going back to the ER or stay in the hospice field and go for the palliative route. Since I started my nursing career, my goal and objective have always been to obtain my Master’s degree and become a nurse practitioner, and now thanks to this course, fulfilling my goal is getting closer. I’m always up for new challenges, and I think that I can grow within my organization, and I believe that this course can help me along with getting my master’s in science of nursing. I am excited to be a part of this class and good luck to everyone!
