Nursing Theory Ch. 2 – Flashcards
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Assumptions
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-Are beliefs about phenomena one must accept as true to accept a theory about a phenomena as true -may be based on accepted knowledge or beliefs and values -can be argued philisophically
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Borrowed or shared theory
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A theory developed in another discipline that is not adapted to the worldview and practice of nursing
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Concept
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-Elements or components of a phenomenon nessesary to understand the phenomenon. -abstract and derived from impressions the human mind receives about phenomena through sensing the environment
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Conceptual model/ framework
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-set of interrelated concepts that symbolically represents and conveys a mental image of a phenomenon. -conceptual models of nursing identify concepts and describe their relationship to the phenomena of central concern to the discipline.
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Construct
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-most complex type of concept -comprised of more than one type of concept and typically built or constructed by the theorist or philosipher to fit a purpose. -concept and construct are often used interchangably; all constructs are concepts but not all concepts are constructs
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Empirical indicator
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-very specific and concrete identifiers of concepts. -are actual instructions, experimental conditions, and procedures used to observe or measure the concepts of a theory.
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Epistemology
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-refers to theories of knowledge or how people come to have knowledge; in nursing its the study of the origins of nursing knowledge.
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Hypothesis
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-are tentative suggestions that a specific relationship exists between two concepts or propositions -as the hypothesis is repeatedly confirmed, it progresses to an empiricle generalization and ultimately to a law.
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Knowledge
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-refers to the awarness of perception of reality aquired through insight, learning or investigation. -in a discipline, knowledge is what is collectivley seen to be a reasonably acurate understanding of the world as seen by members of the discipline.
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Laws
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-a proposition about the relationship between concepts in a theory that has been repeatedly validated. -highly generalizable -found mainly in disciplines that deal with observable and measurable phenomena ie. chemistry and physics. conversely, social and human sciences have few laws.
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Paradigm
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-an organizing framework that contains concepts, theories, assumptions, beliefs, values and principals that form a way the discipline interprets the subject matter with which it is concerned. -describes work to be done and frames an orientation within which the work will be accomplished. -a discipline may have a number of paradigms
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Metaparadigm
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-represents the worldview of a discipline- the global perspective that subsumes more specific views and approaches to the central concepts with which the discipline is concerned -the ideology within which the theories, knowledge, and processes for knowing find meaning and coherence. -nursings metaparadigm is thought to consist of the concepts of person, environment, health and nursing.
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Middle range theory
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-refers to a part of a disciplines concerns related to certain topics. -the scope is narrower than that of broad range or grand theories.
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Nursing theory
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Unique theory and perspectives distinguish different disciplines Multiple definitions for "theory" Nursing theory aims to describe, predict and explain the phenomenon of nursing Foundation for practice, help generate further knowledge
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Model
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-graphic or symbolic representaions of phenomenon that objectify and present certain perspectives or points of view about nature or functions or both. -may be theoretical (something not directly observable-expressed in language or math symbols) or empiracle (replicas of observable reality-model of an eye for eg.)
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Ontology
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concerned with the study of existence and nature of reality
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Phenomena
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-the designation of the aspect of reality -the phenomena of an interest become the subject matter that are the primary concerns of a discipline.
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Philosophy
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a statement of beliefs and values about human being and their world.
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Practice or microtheory
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-deals with a limited range of discrete phenomena that are scientifically defined and are not expanded to include their link with the broad concerns of a discipline.
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Praxis
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the application of a theory to cases encountered in experience.
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Relationship statements
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-indicate specific relationships between two or more concepts. -may be classified as propositions, hypothesis, laws, axioms, or theorems.
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Taxonomy
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-a classification scheme for defining or gathering together various phenomena. -range in a complexity from simple dichotomies to complicated hierarchial structures. -*branch of science concerned with classification*
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Theory
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-refers to a set of logically interrelated concepts, statements, propositions, and definitions, which have been derived from philisophical beliefs or scientific data and from which questions or hypotheses can be deduced, tested and varified. -purports to account for or characterize some phenomenon.
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Worldview
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the philisophical frame of reference used by a social or cultural group to describe that groups outlook on and beliefs about reality.
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Florence Nightingale
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Most nursing scholars credit Florence Nightingale with being the first modern nursing theorist. She was the first to delineate nursing's goal and practice
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Stages of Theory Development in Nursing
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Silent Knowledge Stage Received Knowledge Stage Subjective Knowledge Stage Procedural Knowledge Stage Constructed Knowledge Stage
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Silent Knowledge Stage
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source of knowledge: -blind obediance to medical theory impact on theory and research: -little attempt to develop theory. limited research. -beginning to mid 1940's
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Received Knowledge Stage
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source of knowledge: -learning through listening to others impact on theory and research: -theories were borrowed from other disciplines, Reasearch was mainly educational or sociological research. -do what were told, theories were more borrowed, 1950's time frame
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Subjective Knowledge Stage
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source of knowledge: -authority was internalized, and a new sense of self emerged. impact on theory and research: -a negative attitude toward borrowed theories and science emerged. -nurse scholars focused on defining nursing and on developing theories about and for nursing. -nursing research focused on the nurse rather than the clients and clinical situations. era 1960's
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Procedural Knowledge Stage
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source of knowledge: -includes both seperate and connected knowledge impact on theory and research: -proliferation to approaches of theory development. -application of theory in practice was underemphasized. -emphasis was placed on the procedures used to aquire knowledge, with over attention to the appropriateness of methodology, the criteria for evolution and statistical procedures for data analysis.
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Constructed Knowledge Stage
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source of knowledge: -integration of different types of knowledge (inuition, reason, and self knowledge) impact on theory and research: -nursing theory should be based on prior empiracle studies, theoretical literature, client reports of clinical experiences and feelings, and the nurse scholars intuition or related knowledge about the phenomenon of concern. present day;
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Importance of Theory in Nursing
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Initial work of nursing theory: -Aimed to distinguish nursing domain Theories and models: -Communicate profession of nursing and practice of nursing
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Characteristics of Theories
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Interrelating concepts Logical in nature. Bases for hypotheses Increasing the general body of knowledge within the discipline Used by practitioners to guide and improve their practice. Consistent with other validated theories, laws, and principles but will leave open unanswered questions that need to be investigated.
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Types of Theory (Dickoff & James, 1968)
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Factor-Isolating Theories Factor-Relating Theories Situation-Relating Theories Situation-Producing Theories
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Factor-Isolating Theories
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-descriptive theories -those that describe, observe, and name concepts, properties, and dimensions. Purpose is to provide observation and meaning regarding the phenomena. -does not explain how or why concepts are related
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Factor-Relating Theories
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(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.
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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.
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Situation-Producing Theories
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-theories that prescribe activities necessary to reach defined goals. -address nursing therapeutics and consequences of interventions. -They include propositions that call for change and predict consequences of nursing interventions. They should describe the prescription, the consequence(s), the type of client, and conditions.
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Using a metaphor....
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Aggleton and Chalmers (1986) believe that using the nursing process without theory is like "practicing in the dark". Using a mechanical metaphor, if we take the engine and the body work of a car, the body work is of little use without the engine to drive it and the engine is of little use without the body work to drive around. The nursing process is the engine that makes theories (the bodywork) work in practice. And theories are the bodywork within which the nursing process functions. Source Nursing Theories and Models By Hugh P. McKenna
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Classification of Theories in Nursing
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Most abstract -----> least abstract -Metatheory (foundation) -Grandtheories (outside walls) -Middle range theories (interior walls) -Practice theories (decor) by scope Metatheory Grand Theory Middle Range Theory Practice Theory Partial Theory
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Metatheory
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-a theory about a theory -in nursing, metatheory focuses on broad issues i.e. the process of generating knowledge and theory development and it is a forum for debate within the discipline.
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Grand Theory
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-most complex and broadest in scope. -they attempt to explain broad areas within a discipline and may incorporate numerous other theories. -non specific and comprised of abstract concepts that lack operational definitions. -majority of the nursing conceptual frameworks are considered to be grand theories
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Middle Range Theory
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-lies between nursing models and more concreted ideas (practice theories) -specific and encompass a limited number of concepts and a limited aspect of the real world -comprised of relativley concrete propositions that may be empirically tested.
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Practice Theory
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-also called microtheories, prescriptive theories, or situation specific theories and are the least complex. -more specific than middle range and produce specific directions for practice. -contain fewest concepts and refer to specific easily defined phenomena -usually limited to specific populations/ feilds of practice and often use knowledge from other disciplines. eg. oncology pain managment
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Partial Theory
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-theories in the development stage, not complete. "Theories derived from social sciences, including nursing are probably exclusivley partial theories bc there are few if any phenomena that have been totally and completely explained.
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Issues in Theory Development in Nursing
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1. Nursing's Metaparadigm 2. Concept of Caring in Nursing 3. Borrowed Versus Unique Theory in Nursing
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Nursing's Metaparadigm
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Metaparadigm is the global perspective of a discipline that identifies the primary phenomena of interest to that discipline. Nursing Metaparadigm: Person Health Environment Nursing
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Issue: Not all Theorists agree
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*Interaction* Nursing client *Transitions* *Nursing process* Environment *Nursing therapeutics* Health
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Issue: Caring as Central Construct
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-Debate has been escalating over the past 10 years -Motivated by the perceived need to identify nursing's unique contribution to health care -Many scholars have identified caring as the essence of nursing (Leininger ; Watson) *Several Arguments against this:* -Diverse views as to what caring means -Caring is not unique to nursing -Caring construct seen as gendered and devalued
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Concept of "Concept"
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A concept may be abstract or concrete A single word Two words A phrase The definition of a concept should include consideration of the context of the concept *can be seen as a symbolic statement describing a phenomenon or class of phenomena (Kim) or as a building blocks of theory (Hardy) -A concept can also be seen as a complex mental formulation of experience (Chinn ; Kramer)* The theorist may adjust and re-define concepts and conceptual meaning based on the context of the concept for theory.
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enumerative concept
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-are always present and universal, i.e. age, height, weight
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associative concept
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-exist only in some conditions within a phenomenon; may have zero role value. i.e. income, presence of disease, anxiety
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relational concept
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can be understood only through the combination or interaction of two or more enumerative or associative concepts. i.e. elderly (must combine concepts of age and and longevity) mother (must combine man, woman and birth)
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statistical concept
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relate the property of one thing in terms of its distribution in the population rate, i.e. average BP, HIV/AIDS prevelance rate
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summative concept
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represents an entire complex entity of a phenomenon; are complex and not measurable. i.e. nursing, health and environment
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Types of Concepts in Nursing Literature
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Abstract (general) Versus Concrete (specific) - Independent of time and space vs observable Variable (Continuous) Versus Nonvariable (Discrete) - Blood pressure, pain vs male/female Theoretically Versus Operationally Defined Concepts - Gives meaning of the context of theory vs can be measured using an hypothesis ; can be tested
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Sources of Concepts
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Naturalistic (present in practice) Research-based Existing concepts (borrowed)
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Concept Development ; Analysis
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Purpose: -clarifying, recognizing and defining concepts -Identifying gaps in nursing knowledge -Determining the fit to practice -Context for Concept Development -Development and Frameworks -Development and Research
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Strategies for Concept Analysis and Development
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Multiple Methods -Review of Research Literature -Scholarly Critique -Thoughtful Definition -Choice of a very structured method Wilson (1960s) 1st with 11 steps
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Walker and Avant (1995) 3 processes
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*Analysis*: clarifies, refines or sharpens concepts, statements, or theories. Dissect whole into parts for better understanding. (8 steps- box 3-1) *Synthesis*: combines isolated pieces of information that are theoretically unconnected. *Derivation*: employs analogy or metaphor in transposing a concept, statement or theory from one context to another. *Most well known approach to concept analysis
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Rodgers (2000) context dependent
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1. Identifies concept of interest and associated terms 2. Select an appropriate setting and sample 3. Collecting and managing data 4. Analyzing the data 5. Identifying an exemplar 6. Interpreting the results identify hypothesis and implications 7.* All tasks happen concurrently*
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Swartz-Barcott and Kim (2000)
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*Theoretical Phase* -Select a concept -Review the literature -Determine meaning and measurement -Choose a working definition *Fieldwork Phase* -Set the stage -Negotiate entry into the setting -Select the cases -Collect and analyze the date *Analytical Phase* -Weigh findings -Write the report Looking at concepts in specific situation- what does social support mean in terms of working with older ppl? Younger?
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Meleis (2007) 3 strategies
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1. *Concept Exploration* -Used for new and ambiguous concepts 2. *Concept Clarification* -Purpose is to refine existing concepts 3. *Concept Analysis* -Is for concepts that have been around
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Morse (1995) 3 phases
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1. Concept Delineation 2. Concept Comparison 3. Concept Clarification
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Concept analysis using Walker and Avant approach
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-Aim to gain comprehensive understanding of attributes, antecedents, consequences and applications for practice. -Author interested in looking at how confidence is developed as part of simulation learning. -First step - Select a concept -Conducted review of literature on confidence ; self-efficacy from a variety of perspectives (nursing, psychology, medicine, social sciences) -Developed "cycle of confidence" Second step - determine purpose of analysis Third step - identify all uses of concept Fourth step - determine defining attributes Fifth ; sixths steps - test attributes through development of cases (model, contrary, borderline ; related) Seventh step - identify antecedents and consequences (limited) Eighth step - empirical referents - variety of measures Implications for education - active teaching methods -Problem-based learning -Active learning modalities -Simulation learning Implications for research -Looking at impact of simulation on student learning outcomes. -Looking at link between perceived confidence, learning outcomes ; patient outcomes.
