USING NURSING THEORIES AS FRAMEWORKS FOR PRACTICE, EDUCATION, & RESEARCH Susan S. Gunby, RN, PhD...

USING NURSING THEORIES AS FRAMEWORKS FOR PRACTICE, EDUCATION, &

RESEARCH

Susan S. Gunby, RN, PhD

Fall Semester 2003

“Practicing nurses who despise theory are

condemned to performing a series of tasks – either at

the command of a physician or in response to routines

and policies.”

-- Leah Curtin, RN, MS, FAAN (1989)

Former Editor, Nursing Management

“Theory internalizes principles which increase adaptability and flexibility and enables one to transfer experience from one situation to the next.” -- Leah Curtin

“ . . . the truth thus ascertained would enable us to save life and suffering, and to improve the treatment and management of the sick . . . .”

-- Florence NightingaleProposal presented to the International Statistical Congress in London, 1860

“All must go at the end of 2 months, except

those who are dying.” - Florence Nightingale (1854)

Informed action (simultaneously the action and the knowledge that inform it). (Carr & Kemmis, 1986)

Reflection upon practice toward the refinement of theory and therefore the enhancement of practice. (Thorne & Hayes, 1997)

Discipline of Nursing Must Examine:

• What it means to practice nursing.

• What knowledge is held as “private” vs. “public.”

• What ideals are embedded in nursing practice as well as in the generation of nursing knowledge. (Kim, 2000)

Barbara A. Carper (1978):

•“It is the general conception of any field of inquiry that ultimately determines the kind of knowledge that field aims to develop as well as the manner in which that knowledge is to be organized, tested, and applied . . . .”

Barbara A. Carper (1978):

•“Such an understanding . . . involves critical attention to the question of what it means to know and what kinds of knowledge are held to be of most value in the discipline of nursing.”

WAYS OF KNOWINGor

FORMS OF KNOWLEDGE EmpiricalEthical

PersonalEsthetic

COMPONENTS & LEVEL OF ABSTRACTIONS

Metaparadigm

Philosophies

Conceptual Models

Theories

Empirical Indicators

Most Abstract

Most Concrete

METAPARADIGM

Global concepts that identify the phenomena of

interest

METAPARADIGM

Global propositions that state the relationships

among those phenomena

METAPARADIGM

. . . an encapsulating unit, or framework, within which the morerestricted. . .structures develop.”

(Eckberg & Hill, 1979, p. 927)

METAPARADIGM

The functions of a metaparadigm are to

summarize the intellectual and social missions of a

discipline and place a

boundary on the subject matter of

that discipline. (Kim, 1989)

PHENOMENA OF INTEREST TO NURSING REPRESENTED

BY FOUR CENTRAL CONCEPTS1. Person

2. Environment

3. Health

4. Nursing

PHILOSOPHIESAre Statements About:

*** What people assume to be true in relation to the phenomena of interest to a discipline.

(Christensen & Kenney, 1990)

*** What people believe regarding the development of knowledge about those phenomena.

EXAMPLE OF PHILOSOPHICAL

STATEMENT

“The individual . . . behaves purposefully, not in a sequence

of cause and effect.”(Roy, 1988, p. 32)

CONCEPT

•An abstract idea or mental image of phenomena or reality.

CONCEPTS

• Abstract ideas that give meaning to our perceptions

• Permit generalizations• Stored in memory for

recall & use at later time in a new & different situation.

CONCEPTS

•May be linked together to explain approaches to nursing care and to predict the outcome of care.

Concepts

•When operationalized, become variables used in hypotheses to be tested in research.

•Explicate subject matter of theories of a discipline.

CONCEPTUAL MODELS

A set of abstract and general concepts and propositions

that integrate those concepts into a meaningful

configuration. (Lippitt, 1973; Nye & Berardo, 1981)

CONCEPTUAL MODELS

Provide a distinctive frame of reference.

EXAMPLES OF CONCEPTUAL MODELS

*** King’s General Systems Framework

*** Roy’s Adaptation Model

THEORIES

Consist of relatively specific and concrete concepts

and propositions that purport to account for or organize some phenomenon. (Barnum, 1994)

THEORIES

Vary in the relative level of concreteness

and specificity of their concepts and

propositions.

THEORIES

Primary Purpose:

To generate knowledge.

THEORIES

Provide a communication system in terms of a set of concepts that are interrelated and understandable to others.

THEORIES

Enable nurses to know WHY they are doing WHAT they

are doing.

THEORIES

Provide knowledge to improve practice & education by describing, explaining, predicting, controlling, and understanding phenomena.

THEORIES

Help develop analytical skills, challenge thinking, clarify values and assumptions, and determine purposes for nursing practice, education, and research.

THEORIES

Enhance professional autonomy by guiding the practice, education, and research functions of the profession.

EMPIRICAL INDICATORS

The actual instruments, experimental conditions,and research methodologies used to observe ormeasure the concepts of a middle-range theory.