Introduction to Nursing Theory – Flashcards
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what are the building blocks of theory
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concepts
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philosophy is
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a set of ideas or beliefs, provides perspective for practice
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concepts are
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concrete and can be operationally defined, building blocks of theory
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propositions
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statements if a constant relationship between 2 or more concepts or facts
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nursing theories are more blank then conceptual models
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specific
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theory that is broad in scope, highly abstract is
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grand theory
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theory that is narrow scope, concrete is
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middle range
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middle range theories have
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fewer concepts and propositions, limited view of nursing reality, appropriate for testing, applicable to practice
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practice theories are
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easily defined, fewer concepts, situation specific ex oncology
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nursing science refers to
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system of relationships of human responses in health and illness, directs future nursing
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knowledge development in nursing reflects
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interface between nursing science and research, gaol is improve practice
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what is nursing theory
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an attempt to explain patterns and relationships found in nursing phenomena
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why do we study nursing theory
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enriches practice, reframe thinging about nursing, organizes knowledge, explains, interprets, describes experiences, guides actions, predicts outcomes
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assumptions
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beliefs about phenomena that one must accept as true to accept a theory
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grand theories
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discuss broad nursing practice areas
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middle range theories discuss
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specific nursing actions, processes or concepts
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what year did theory develop
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1950's
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peplau 1952
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therapeutic interpersonal process
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henderson 1955
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14 basic needs
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rogers 1970
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humanistic science of nursing
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orem 1971
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self care deficit
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roy 1979
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adaptation
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watson 1979
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philosophy of caring
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theory is influenced by
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personal values and beliefs, clinical practice, history, knowledge in nursing science
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empirics
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science of nursing
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esthetics
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art of nursing
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personal knowledge
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use of self
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ethics
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moral knowledge
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examples of borrowed theories
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systems theory, adaptation to stress, interpersonal theory (sullivan's)
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borrowed theories are
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derived from theories developed by related disciplines
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steps in theory development
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concept development, statement development, theory construction, testing of theory, theory application
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concept development purpose
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clarifying, recognizing, defining concepts
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testing of theoretical relationship is
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validates relationship in practice
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theory application
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how theory works in practice
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theory evaluation is defined as a
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systematic process, identifies usefulness to guide practice, research, education, determines strengths and weeknesses
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nursing theories provide the
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critical thinking structures to direct the clinical decision making process
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philosophies of nursing describes the
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professions belief system, provides perspectives for practice, contribute to the discipline by providing direction, ex nightingale, henderson, watson, benner
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Stages of Nursing Theory Development
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Silent Knowledge Received Knowledge Subjective Knowledge Procedural Knowledge Constructed Knowledge
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Silent Knowledge
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Blind obedience to medical authority Following orders because that is what the physician said to do, little attempt to develop theory
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Received knowledge
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Learning through listening to others Borrowing theories from other disciplines (sociology, education, medicine)
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Subjective knowledge
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Authority was internalized and a new sense of self emerged Focusing on defining nursing and developing theories
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Procedural knowledge
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Includes both separate and connected knowledge. Difficulty attaching theory to practice
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Constructed knowledge
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Integration of different types of knowledge (intuition, reason, and self-knowledge) Shift from grand theories to middle and practice theories
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Components of a Theory
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Purpose, Concepts/definitions, Theoretical statements, Structure/linkages, Assumptions
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Phenomenon
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An aspect of reality that can be observed or experienced. Phenomena can be sensed, it is real e.g. a patient's response (for example to stress which causes the blood sugar to increase) or response to a treatment. It is "the thing" that gets you started or thinking.
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Concepts
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Elements of a phenomenon that are necessary to understand the phenomenon. Concepts is the glossary of terms that is used to describe the phenomena. Examples of concepts might be stressors, defense mechanisms, ideas that the patient have that make them respond in a particular way.
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Definitions
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Communicates the general meanings of the concepts involved. The definitions describe it, e.g. a patient with diabetes reacting by refusing to give up regular sodas.
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Assumptions
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Beliefs about the phenomena that one must accept as true to accept the theory to be true. Assumptions can be the normal range of responses expected during stress for example. It is usually common knowledge.
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Grand Theories
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-Broadest in scope - Most complex - Non-specific & comprised of relatively abstract concepts - Generally cannot be tested - Provides broad & abstract views about nursing Example - 1. Neuman Systems Model about client responses, environmental factors and nursing actions is a foundation for nursing practice, education and research.
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Middle Range Theories
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- More limited in scope - Less abstract - Address a specific phenomenon - Reflect practice - Comprised of relatively concrete concepts - May be tested Example - 1. Mishel's theories about uncertainty in illness, may help a nurse to assist patients in coping with cancer.
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Developmental Theories
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Human growth and development is an orderly predictive process that begins with conception and continues through death.
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Linking Theory to Practice
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Theory provides a framework for research - Research builds nursing knowledge used in practice - Practice leads to more research question and thus more theories
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Nightingaleâ1860 (Potter , Patricia A. . Fundamentals of Nursing (With Media), 7th Edition. Mosby, 032008. p. 49).
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Facilitate "the body's reparative processes" by manipulating client's environment Nurse manipulates client's environment to include appropriate noise, nutrition, hygiene, light, comfort, socialization, and hope. Environmental Theory
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Definition and use of theory
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Theory is a systematic way of explaining and organizing information about a phenomena. It is a way we can explain the world around us. It is a way we can group ideas, synthesize the information and form new ideas. Nurses can use theory to help understand their practice better and help form ways to improve practice out of that understanding.
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Hypothesis
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tentative suggestions that a relationship exists between concepts or propositions. With further confirmation, goes on to empirical generalization and ultimately a law
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Law
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a proposition about a relationship between concepts that has been validated so many times it is considered true and is highly generalizable. It is usually found in disciplines with observable and measurable phenomena such as chemistry and physics.
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Metaparadigm
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Global concepts that identify the phenomena of interest to a discipline. Broadest description of a discipline. Ex: Environment, Health, Person, Nursing = Nursing Metaparadigm.
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Conceptual Model
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set of interrelated concepts that symbolically represent and convey a mental image of the phenomena of interest.
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Science
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both a process and a product. Way of explaining observed phenomena and a system of gathering, verifying and systematizing information about a reality.
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Founder of Modern Nursing
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Florence Nightingale got formal training in Germany in 1851, served the British Army in the Crimean war, established a nursing school in London. She was called the "Lady of the Lamp" because of her nightly rounds. Dealt with the deplorable dirty conditions the soldiers lived in. Because of her experience in the Crimean war, she taught that people need not just medical care, but also clean air, water, and a clean environment.
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What drove development of nursing knowledge
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In the early 1900s there were numbers of diploma programs. Most hospitals used nurses as cheap labor and worked them long hard days, 7 days a week. Nurses were trained by the apprenticeship model (as were physicians) which meant you only learned as much as your mentor. There were a couple of reports that really sparked change in nursing education: Goldmark and Flexner. The wars had influence, because women were then needed in the workforce and with the GI bill they were able to get funding for a formal education. In 1950 the nursing journal Nursing Research was published. There were many more hospitals after the war and this created a nursing shortage. Esther Brown wrote an article and compared nurses to teachers. The women's movement influenced education for women as well, and the field was predominantly women. Nurses were encouraged to go for higher degrees. The first doctoral programs for nursing were started in the 30's but there was slow growth in this area for many years. By 1970 there were only 20 programs, but in the 21st century the numbers of these programs have grown dramatically. The growth in these programs through time allowed nurses the opportunity to debate ideas, viewpoints and research methods. In the 1980's there were many books written on how to critique, develop and apply theory.
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Five stages of development of nursing knowledge
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Silent knowledge--blind obedience to medical authority Received knowledgeâlearning through listening to others Subjective knowledgeâauthority internalized and new sense of self emerged; nurse scholars focused on defining nursing and dev theories about and for nursing Procedural knowledgeâincludes both separate and connected knowledge; proliferation of approaches to theory development; over-attention to appropriateness of methodology, stats for data analysis Constructed knowledgeâintegration of different types of knowledge (intuition, reason and self-knowledge) nursing theory should be based on prior empirical studies, theoretical literature, client reports of clinical experiences and feelings and the nurse scholar's intuition or related knowledge about the phenomenon of concern.
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Tie theory, research and science together
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Science is both a process and a product. Theoretical explanations are used to explain parts and relationships within science. Research is used to strengthen the understanding of the relationships proposed in theories.
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What are the 4 purpose theory classifications
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a. Factor isolating theories ( descriptive theories) b. Factor-relating theories (explanatory theories) c. Situation relating theories (predictive theories and promoting or inhibiting theories d. Situation-producing theories (prescriptive theories)
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Ontology
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Study of theory of being (what is or what exists).
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Epistemology
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Study of knowledge (ways of knowing, nature of truth, and relationship between knowledge and belief). -What do we know? -What is the extent of our knowledge? -How do we decide what we know? -What are the criteria of knowledge?
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Philosophy of Science
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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. -Study of science and scientific practice.
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Nursing Philosophy
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A statement of foundational and universal assumptions, beliefs, and principals 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)).
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Nursing Science
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The substantive, discipline specific knowledge that focuses on the human-universe-health process articulated in the nursing frameworks and theories. -Recognizes the relationships of human responses in health and illness and addresses biologic, behavioral, social, and cultural domains.
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3 approaches knowledge development in nursing
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1. Ontology 2. Epistemology 3. Methodology
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Methodology
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Means for acquiring knowledge.
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Nursing Epistemology
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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.
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Requirements for a Metaparadigm
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1. Must identify a domain that is distinctive from the domains of other disciplines... the concepts and propositions represent a unique perspective for inquire and practice. 2. Must encompass all phenomena of interest to the discipline in a parsimonious manner... the concepts and propositions are global and there are no redundancies. 3. Must be perspective-neutral... the concepts and propositions do not represent a specific perspective (i.e., a specific paradigm or conceptual model or combination of perspectives). 4. Must be global in scope or substance... the concepts and propositions do not reflect particular national cultural, or ethnic beliefs and values.
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Received View
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Individuals learned by being told or receiving knowledge. -Empiricism, positivism, and logical positivism.
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Perceived View
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Centers on the descriptions that are derived from collectively lived experiences, interrelatedness, human interpretation, and learned reality as opposed to artificially invented (i.e., laboratory-based) reality. -Human science, phenomenology, constructivism, historicism.
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Empiricism
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Founded in the belief that what is experienced is what exists. Requires that these experiences be verified through scientific methodology. Strives to explain nature through testing of hypotheses and development of theories.
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Positivism
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Supports mechanistic, reductionist principles, where the complex can be best understood in terms of its basic components. Often equated with empiricism.
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Positivism>Postpositivism
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Although positivism continues to heavily influence nursing science, that viewpoint has been challenged in recent years. Consequently, postpositivism has become one of the most accepted contemporary worldviews in nursing.
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Phemenology
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Study of phenomena and emphasizes the appearance of things as opposed to the things themselves. Understanding is the goal of science, with the objective of recognizing the connection between one's experience, values, and perspective.
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Constructivism
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Focus on understanding the actions of, and meaning to, individuals. What exists depends on what individuals perceive exists.
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Quantitative Research Methodology
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Scientist develops a hypothesis about a phenomenon and seeks to prove or disprove it. Has been justified by its success in measuring, analyzing, replicating, and applying knowledge gained.
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Qualitative Research Methodology
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Answer questions centered on social experience and give meaning to human life. Contains features of good science including theory and observation, logic, precision, clarity, and reproducibility.
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Methodologic Pluralism Research Methodology
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Nursing is undecided if it is qualitative or quantitative research methodology because each method has its strengths and limitations. This form of methodology considers both methods complimentary.
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Scope of Theories
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1. Metatheory (Most Abstract) 2. Grand Theories 3. Middle Range Theories 4. Practice Theories (Least Abstract)
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Metatheory
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Refers to a theory about theory. Focuses on broad issues such as the processes of generating knowledge and theory development. Recent metatheoretical issues relate to philosophy of nursing and address what levels of theory development are needed for nursing practice, research, and education.
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Grand Theories
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Are the most complex and broadest in scope. Nonspecific and composed of relatively abstract concepts that lack operational definitions. The majority of nursing conceptual frameworks are considered to be this.
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Middle Range Theories
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Lie between the grand nursing models and more circumscribed, concrete ideas (practice or situation-specific theories). Substantively specific and encompass a limited number of concepts and a limited aspect of the real world. May be: 1. A description of a particular phenomenon. 2. An explanation of the relationship between phenomena. 3. A prediction of the effects of one phenomena or another. Ex: Social support, quality of life, and health promotion.
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Practice Theories
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More specific than middle range theories and produce specific directions for practice. Contain the fewest concepts and refer to specific, easily defined phenomena. Narrow in scope and explain a small aspect of reality. Also called situation-specific theories, perspective theories, and microtheories. Ex: Postpartum depression, infant boding, and oncology pain management.
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Descriptive (Factor-isolating) Theories
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Theories that describe, observe, and name concepts, properties and dimensions. Identifies and describes the major concepts of phenomena but does not explain how or why the concepts are related. The purpose is to provide observation and meaning regarding the phenomena. It is generated and tested by descriptive research techniques including concept analysis, case studies, literature review phenomenology, ethnography, and grounded theory.
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Explanatory (Factor-Relating) Theories
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Also known as factor-relating theories. Theories that relate concepts to one another, describe the interrelationships among concepts or propositions, and specify the associations or relationships among some concepts. Attempt to tell how or why the concepts are related and may deal with cause and effect and correlations or rules that regulate interactions.
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Predictive (Situation-Relating) Theories
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Achieved when the conditions under which concepts are related are stated and the relational statements are able to describe future outcomes consistently. Relatively difficult to find in nursing literature.
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Prescriptive (Situation-Producing) Theories
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Theories that prescribe activities necessary to reach defined goals. Address nursing therapeutics and consequences of interventions. Include propositions that call for change and predict consequences of nursing interventions. Most difficult to identify in nursing literature.
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What is a theory?
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set of interrelated concepts that give a systematic view of a phenomenon, guide and support a profession: practice, education, and research, organized, representation of reality, guides research, validates **describe, explain, predict, control
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Words that describe objects, properties, or events. They are labels for phenomena, basic components of a theory, represent aspect of reality, describe mental images of phenomena
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concept
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concept that is easily understood
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empirical
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concept that is indirectly observable
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inferential
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concept that is non-observable
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abstract
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Statements that link concepts and explain the relationship between variables
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propositions
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statements of facts or beliefs that people accept as the underlying theoretical foundation, derived from scientific theory or practice
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assumptions
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statement of beliefs or values, what people assume to be true
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philosophy
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Environment, health, nursing, person -global concepts
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metaparadigm
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representations of the interaction among and between concept showing patterns
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models
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a set of abstract and general concepts and the propositions that integrate those concepts into a meaningful configuration
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conceptual models
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broad in scope, less abstract, cannot be tested empirically
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grand theory
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narrower in scope, made up of concepts and propositions that are empirically measurable
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middle range theory
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relationship between 2 or more concepts, states the relationship in a form to be tested
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hypothesis
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utilization of a theory
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theories guide research, research validates theory, theory and research enhance practice
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Metaparadigm: totality
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Orem -received view, objective, measurable, scientific method, quantitative
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Metaparadigm: simultaneity
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Rogers -perceived view, subjective, "how do you feel", human experience, qualitative
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Origins of theories
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induction: specific to general; research--> theory deduction: general to specific; theory--> research
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Phenomenon
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aspect of reality that people consciously sense or experience
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Scientific process- Ontology- standard, Epistemology knowledge leads to knowledge, Ethics Exact
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Positivism- only real if can be objectified or quantified, controlled exp with empirical measurements, biased free value
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Science cant solve all problems- O: synthesized, E: approximate knowledge leads to approximate knowledge, E: Explanatory
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Post-positivism- reality cant be known/info different sources, scientific method deal with human life, acknowledges own values but objective
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Reality created by social systems- O: Social, E: knowledge is created, E: Emancipation
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Critical Theory- Social reality, working with who is involved, liberate or emancipate the people who oppose
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Understanding actions and meaning to individuals/investigation of the individual world- O: Subjective, E: knowledge is experienced, E: Empathy
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Constructivism- experience of a person, elicit experiences and perceptions, emphasize on what person is experiencing
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a statement of foundational and universal assumptions, entities rep in the metaparadigm- belief system, worldview
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Nursing Philosophy
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knowledge that focuses on the human-universe-health process articulated in frameworks and theories- goal to understand and explain it
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Nursing Science
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helps establish meaning of science through an understanding and examination of nursing concepts, theories, laws, and aims as they relate to nursing practice
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Philosophy of Science in Nursing
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Three Facets of Knowledge Development
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OEM- Ontology, Epistemology, Methodology
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Study of being, what is and what exists
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Ontology
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Study of knowledge and ways of knowing
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Epistemology
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Means of acquiring knowledge
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Methodology
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Basics types of Epistemology
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Empirics, personal knowledge, intuitive knowledge, Somatic knowledge, metaphysical knowledge, esthetics, Moral
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scientific form of knowing, comes from observation, testing, and replication
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Empirics
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pertains to knowledge gained from thought alone
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Personal Knowledge
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includes feelings and hunches, nonconscious pattern of recognition and experience
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Intuitive Knowledge
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knowledge of body in relation to physical movement
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Somatic Knowledge
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seeking presence of higher power- spiritual
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Metaphysical Knowledge
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knowledge r/t beauty, harmony, expression
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Esthetics
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knowledge of what is right and wrong
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Moral or Ethical Knowledge
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2 forms of scientific inquiry
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Empiricism and Phenomenology
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Empiricism
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Objective experience and testing, controlled
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Phenomenology
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study of lived experiences and meanings
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Ways in which theories have influenced nursing practice:
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ID certain standards ID settings in which nursing practice should take place ID distinctive nursing process Direct delivery of nursing services Serve as a basis for clinical info: admission, nursing orders, care plan, progress note, discharge Guide development of client satisfaction Direct quality assurance programs
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Stages in Development of Nursing Theory
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Silent Knowledge Received Knowledge Subjective Knowledge Procedural Knowledge Constructed Knowledge Integrated Knowledge
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Classifications of Theory
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Scope: Metatheory, Grand Theory, Middle Range, Practice Purpose: Descriptive, Explanatory, Predictive, Prescriptive
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Theory about a theory, broad issues
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Metatheory
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most complex, broadest scope, nonspecific, abstract
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Grand Theories
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less abstract, limited number of concepts, limited aspect, may be empirically tested
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Middle Range Theory
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least complex, more specific, narrow, specific direction for practice, usually limited to specific fields or populations
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Practice Theory
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Situation Producing
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Prescriptive
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Factor Isolation
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Descriptive
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Factor Relating
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Explanatory
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Situation Relating
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Predictive
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Types of Concept Characteristics "EARRS"
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Enumerative Associative Relational Statistical Summative
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Functions of Concepts
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Means to organize and classify information, building blocks conceptual frame works and to construct theories, allow describe, explain, predict events
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Purpose of Concept Analysis
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ID gaps in nursing knowledge Determine need to refine or clarify concept when it appears to have multiple meanings Evaluate adequacy of competing concepts Exam definition and way it has been operationalized Determine fit between concept and clinical application
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Strategy/Steps in Concept Analysis
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- Select a concept - ID all the uses for at least 2 disciplines - Determine defining attributes - ID antecedents and consequences
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Attributes
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characteristics of concept
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Antecedents
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Events/incidents that must occur or be in place prior to occurrence
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Consequences
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Events/incidents that occur as a result of the occurrence of the concept- outcomes of the concepts
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Theoretical Definition
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provides meaning by defining concept using critical attributes
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Operational Definition
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reflect on theoretical definition, must state observation and or activities that will measure the concept
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Components of Theory
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Purpose, concepts and conceptual definitions, theoretical statements, structure and linkages, Assumptions
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Purpose:
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explains why, may discuss background of theorists and time that it was written in society
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Concepts and definitions
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concepts are building blocks, theoretical and operational definitions of the concpet
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Theoretical Statements
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are statements about the relationship between two or more concepts and are used t connect concepts and devise theory
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Structure and Linkages
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structuring theory in logical arrangement and specifiy linkages of the theoretical concepts and statements is critical to the development- structure provides overall form and linkages offer reasoned explanation of why the variables in the theory may be connected in some manner
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Assumptions (Component of Theory)
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notations that are taken to be true without proof- beliegs about the phenomenom that one must accept as true to accept the theory
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Process of Theory Development
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Concept Development Statement Development Theory Construction Testing Theoretical Relationships Application of Theory in Practice
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Concept Development
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specifying, defining, clarifying the concepts used to describe a phenomena
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Statement Development
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Formulating and analyzing statements explaining relationships between concepts- also determining empirical referents that can validate them
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Theory Construction
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structuring and contectualizing the components of the theory; includes identifying assumptions and organizing linkages between and among the concepts and statements to form a theoretical structure
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Testing Theoretical relationships
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Validating theoretical relationships through empirical testing
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Application of Theory in practice
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using research methods to assess how the theory can be applied in practice
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Logical Thinking- Inductive
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beginning with specifics and moving to global/generalized conclusions- induced from a # of specific, not clearly developed, all must be validated because not all instances have been observed
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Logical Thinking- Deductive
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Begin with broad statements and move to specifics - Conclusions derived from 2 general premises - premises sound and format valid, conclusion is true - conclusion provide no new information - conclusion deduced from 2 general premises, but has yet to be verified by clinical research - starting premises false, conclusion will be false - determine if premises true by supporting evidence
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Axiom
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basic set of statements or propositions that state the general relationship between concepts
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Conceptual Model
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set of interrelated concepts that symbolically reps and conveys a mental image of a phenomenom- identify concepts and describes their relationships
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Empirical Generalizations
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summarize empirical evidence- some confidence that the same pattern will be repeated in concrete situations in the future under same conditions
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Empirical Indicator
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specific and concrete indentifiers of a concept- actual instructions, experimental conditions, and procedure used to observe or measure
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Laws
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Propositions about the relationship between concepts in a theory that has been repeatedly verified
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Praxis
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application of theory to cases encountered in experience
